package com.example.myyiyanmengjava.bean;

import java.util.List;

/**
 * 作者：朱勇闯
 * data : 2021/5/11  15:32
 * 作用： 内科
 */
public class SheetBean {

    /**
     * ret : 200
     * info : {"list":[{"id":"69","name":"阿司匹林引起NSAID溃疡的最主要致溃疡机制是：","data":{"A":"抑制COX-1","B":"抑制COX-2","C":"同时抑制COX-1和COX-2","D":"局部作用"},"da_an":"A","typeid":"117","time":"2005-07-01 14:38:19","xiang_jie":"[答案]A\r\n[考点]阿司匹林的作用机制\r\n[考点还原]（P363）\u201cNSAIDs致胃黏膜病变的主要机理是通过小肠吸收后，对黏膜COX-1抑制，因此，肠溶型的NSAIDs依旧可以导致急性胃炎\u201d（A对）。\r\n[解析]NSAID的系统作用主要是抑制环氧合酶（COX）。COX有两种异构体，即COX-1和COX-2。COX-1催化生理性前列腺素合成，参与机体正常生理功能调节及保护，如维持胃肠黏膜完整。COX-2主要在病理情况下由炎症刺激诱导产生，促进炎症部位前列腺素的合成。传统的NSAID如阿司匹林抑制了COX-1，使胃肠黏膜生理性前列腺素E合成不足，导致胃肠道出现黏膜病变（溃疡）。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"2042","all_num":"2706","types":0,"pname":"内科学"},{"id":"74","name":"原发性肝癌早期的转移方式主要是：","data":{"A":"肝外血转移","B":"淋巴转移","C":"种植转移","D":"肝内转移"},"da_an":"D","typeid":"117","time":"2005-07-01 14:40:10","xiang_jie":"[答案]D\r\n[考点]原发性肝癌的转移方式\r\n[考点还原]（P430）\u201c2.肝外转移①血行转移：最常见转移至肺\u2026②淋巴转移：常见肝门淋巴结转移\u2026③种植转移：少见\u2026女性可有卵巢转移\u201d（八版病理学P215）\u201c癌组织首先在肝内直接蔓延，易经肝内沿门静脉分支播散、转移，使肝内出现多处转移结节\u201d（14版实用内科学P2036）\u201c肝内血行转移发生最早，也最常见，是肝癌切除术后早期复发的主要原因\u201d（D对）。\r\n[解析]原发性肝癌是我国常见的恶性肿瘤之一。原发性肝癌早期的转移方式是肝内转移。而其他的转移方式（肝外血转移、淋巴转移、种植转移）均为肝外转移。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"2472","all_num":"2663","types":0,"pname":"内科学"},{"id":"79","name":"男性，53岁，肝硬化病史8年。5天来无明显原因出现腹胀，腹水迅速增加，脾脏进一步增大，体温正常。最可能发生的并发症是：","data":{"A":"原发性肝细胞癌","B":"原发性腹膜炎","C":"门静脉血栓形成","D":"肝肾综合征"},"da_an":"C","typeid":"117","time":"2005-07-01 14:41:56","xiang_jie":"[答案]C\r\n[考点]肝硬化并发症\r\n[考点还原]（P424）\u201c门静脉血栓形成的临床表现变化较大\u2026急性或亚急性发展时，表现为中重度腹胀或突发剧烈腹痛、脾大、顽固性腹水、肠坏死、消化道出血及肝性脑病等，腹穿可抽出出血性腹水\u201d（C对）。\r\n[解析]该中年男性患者有肝硬化病史，最近短期内无明显原因出现腹胀，腹水迅速增加，脾脏进一步增大，体温正常，最可能发生的并发症是门静脉血栓形成。其余选项亦均为肝硬化的并发症，但原发性肝细胞癌不会腹水如此迅速增加和脾脏进一步增大，而主要是肝脏增大；原发性腹膜炎主要是腹痛和发热，该患者不像；肝肾综合征是因肾血管收缩导致肾皮质血流量和肾小球滤过率持续降低引起功能性肾衰竭，其特征为自发性少尿、氮质血症、稀释性低钠血症、低尿钠、尿比重升高等，该患者也不可能。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1598","all_num":"2061","types":0,"pname":"内科学"},{"id":"84","name":"男性，54岁。近2个月来反酸、烧心，多于餐后出现，平卧位时明显，5天来情况严重，有时伴有胸骨后疼痛，ECG检查未见明显异常，胃镜检查可见食管黏膜破损融合。该患者最可能的诊断是：","data":{"A":"胃食管反流病","B":"心绞痛","C":"食管憩室炎","D":"食管癌"},"da_an":"A","typeid":"117","time":"2018-10-11 19:36:22","xiang_jie":"[考点]胃食管反流病的诊断和治疗\r\n\r\n[考点还原]（P357）\u201c1.典型症状烧心和反流是本病最常见和典型的症状\u2026烧心和反流常在餐后1小时出现，卧位、弯腰或腹压增高时可加重\u201d（P357）\u201c2.非典型症状胸痛由反流物刺激食管引起，发生在胸骨后\u201d（P358）\u201c（一）胃镜是诊断RE最准确的方法\u2026胃镜下RE分级（洛杉矶分级法）如下：正常：食管黏膜没有破损\u2026C级：黏膜破损有融合，但小于75%的食管周径；D级：黏膜破损融合，至少达到75%的食管周径\u201d（P358）\u201cGERD的诊断是基于：①有反流症状；②胃镜下发现RE；③食管过度酸反流的客观证据。如患者有典型的烧心和反酸症状，可作出GERD的初步诊断。胃镜检查如发现有RE并能排除其他原因引起的食管病变，本病诊断可成立\u201d（A对）。\r\n[解析]该中年男性患者主诉为反酸、烧心，多于餐后出现，平卧位时明显，胃镜检查可见食管黏膜破损融合，这些均支持胃食管反流病的诊断。胃食管反流病是指胃、十二指肠内容物反流入食管所引起烧心和反酸等症状，可有胸骨后痛，放射至后背肩部及耳部等，酷似心绞痛，疼痛与酸反流有关，故又称为非心源性胸痛。胃食管反流病选用的治疗是奥美拉唑，不需要手术，氢氧化铝的抗酸疗效差，硝酸甘油是适用于心绞痛。维持治疗选用的最佳药物也是奥美拉唑。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1952","all_num":"1992","types":0,"pname":"内科学"},{"id":"89","name":"男性，54岁。近2个月来反酸、烧心，多于餐后出现，平卧位时明显，5天来情况严重，有时伴有胸骨后疼痛，ECG检查未见明显异常，胃镜检查可见食管黏膜破损融合。选用的治疗是：","data":{"A":"氢氧化铝","B":"硝酸甘油","C":"奥美拉唑","D":"手术"},"da_an":"C","typeid":"117","time":"2018-10-10 00:26:40","xiang_jie":"[考点]胃食管反流病的诊断和治疗\r\n\r\n[考点还原]（P359）\u201c2.抑酸药对初次接受治疗的患者或有食管炎的患者宜以PPI治疗，以求迅速控制症状、治愈食管炎\u201d（P359）\u201cPPI\u2026适用于症状重、有严重食管炎的患者\u201d（C对）。\r\n[解析]该中年男性患者主诉为反酸、烧心，多于餐后出现，平卧位时明显，胃镜检查可见食管黏膜破损融合，这些均支持胃食管反流病的诊断。胃食管反流病是指胃、十二指肠内容物反流入食管所引起烧心和反酸等症状，可有胸骨后痛，放射至后背肩部及耳部等，酷似心绞痛，疼痛与酸反流有关，故又称为非心源性胸痛。胃食管反流病选用的治疗是奥美拉唑，不需要手术，氢氧化铝的抗酸疗效差，硝酸甘油是适用于心绞痛。维持治疗选用的最佳药物也是奥美拉唑。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1809","all_num":"1974","types":0,"pname":"内科学"},{"id":"97","name":"男性，54岁。近2个月来反酸、烧心，多于餐后出现，平卧位时明显，5天来情况严重，有时伴有胸骨后疼痛，ECG检查未见明显异常，胃镜检查可见食管黏膜破损融合。若维持治疗，选用的最佳药物是：","data":{"A":"雷尼替丁","B":"奥美拉唑","C":"硝酸异山梨酯","D":"顺铂和5-氟尿嘧啶"},"da_an":"B","typeid":"117","time":"2018-10-11 19:34:27","xiang_jie":"[考点]胃食管反流病的诊断和治疗\r\n\r\n[考点还原]（P357）\u201c烧心和反流是本病最常见和典型的症状...烧心是指胸骨后或剑突下烧灼感，常由胸骨下段向上延伸。烧心和反流常在餐后1小时出现，卧位、弯腰或腹压增高时可加重，部分患者烧心和反流症状可在夜间入睡时发生\u201d，（P359）\u201c（二）维持治疗...PPI和H\u2082RA均可用于维持治疗，PPI效果更优\u201d（B对）\r\n[解析]该中年男性患者主诉为反酸、烧心，多于餐后出现，平卧位时明显，胃镜检查可见食管黏膜破损融合，这些均支持胃食管反流病的诊断。胃食管反流病是指胃、十二指肠内容物反流入食管所引起烧心和反酸等症状，可有胸骨后痛，放射至后背肩部及耳部等，酷似心绞痛，疼痛与酸反流有关，故又称为非心源性胸痛。胃食管反流病选用的治疗是奥美拉唑，不需要手术，氢氧化铝的抗酸疗效差，硝酸甘油是适用于心绞痛。维持治疗选用的最佳药物也是奥美拉唑。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1796","all_num":"1930","types":0,"pname":"内科学"},{"id":"103","name":"诊断胃食管反流病最准确的方法是：","data":{"A":"食管吞钡X线检查","B":"食管测压","C":"24小时食管pH监测","D":"胃镜检查"},"da_an":"D","typeid":"117","time":"2005-07-01 14:51:10","xiang_jie":"[答案]D\r\n[考点]胃食管反流病的诊断\r\n[考点还原]（P358）\u201c（一）胃镜  是诊断RE最准确的方法，并能判断RE的严重程度和有无并发症\u201d（D对）。\r\n[解析]胃食管反流病是指胃、十二指肠内容物反流入食管所引起\u201c烧心\u201d等症状，并可导致食管和咽喉、气管等组织损害的疾病。胃镜下有反流性食管炎表现，有反流性食管炎的表现即可诊断。因此诊断胃食管反流病最准确的方法是胃镜检查。其他检查（食管吞钡X线检查、食管测压和24小时食管pH监测）对诊断有帮助，但不能确诊。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1278","all_num":"1448","types":0,"pname":"内科学"},{"id":"108","name":"临床上服用下列药物时，不影响对幽门螺杆菌病原检测的是：","data":{"A":"奥美拉唑","B":"枸橼酸铋钾","C":"米索前列醇","D":"呋喃唑酮"},"da_an":"C","typeid":"117","time":"2005-07-01 14:52:28","xiang_jie":"[答案]C\r\n[考点]幽门螺杆菌的治疗\r\n[考点还原]（P372）\u201cPPI可增强抗Hp抗生素的杀菌作用\u201d（A错）。（P373）\u201c铋剂还可通过包裹Hp菌体，干扰Hp代谢，发挥杀菌作用\u201d（B错）。\r\n[解析]质子泵抑制剂（如奥美拉唑）、胶体铋剂（如枸橼酸铋钾）和抗生素（如阿莫西林、克拉霉素、甲硝唑、替硝唑、四环素及呋喃唑酮等）可杀灭幽门螺杆菌，而米索前列醇对幽门螺杆菌无作用。所以临床上服用米索前列醇时，不影响对幽门螺杆菌病原的检测。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1144","all_num":"1430","types":0,"pname":"内科学"},{"id":"113","name":"男性，45岁。间断发生腹痛、腹泻5年，发作时大便2~4次/天，有时便中有黏液，无脓血，排便后腹痛可缓解，因再发1周来诊。查体：左下腹轻压痛。化验粪常规：WBC 0~1/HP，隐血试验（－），细菌培养（－）。该患者最可能的诊断是：","data":{"A":"慢性细菌性痢疾","B":"肠易激综合征","C":"克罗恩病","D":"溃疡性结肠炎"},"da_an":"B","typeid":"117","time":"2018-11-17 15:26:05","xiang_jie":"[答案]B\r\n[考点]肠易激综合征的诊断\r\n[考点还原]（P386）\u201c1.腹泻和黏液脓血便  见于绝大多数患者\u201d（P387）\u201c（二）粪便  肉眼观常有黏液脓血，显微镜检见红细胞和脓细胞\u201d（D错）。（P390）\u201c体检常有腹部压痛，部位多在右下腹\u201d（C错）。（P399）\u201c患者以中青年居多\u201d（P400）\u201c症状反复发作或慢性迁延\u2026几乎所有IBS患者都有不同程度的腹痛或腹部不适，部位不定，以下腹和左下腹多见，排便或排气后缓解。极少有睡眠中痛醒者。腹泻型IBS常排便较急，粪便呈糊状或稀水样便，一般每日3～5次左右，少数严重发作期可达十余次，可带有黏液，但无脓血\u201d（B对）。（八版病理P360）\u201c由于炎症刺激\u2026导致里急后重和排便次数增多\u2026最初为稀便混有黏液，后转为黏液脓血便，偶尔排出片状假膜\u201d（A错）。\r\n[解析]该中年男性患者呈慢性病程，间断发生腹痛、腹泻，发作时大便次数增多（2〜4次/天），有时便中有黏液，但无脓血，排便后腹痛可缓解，结合左下腹轻压痛及化验粪常规见极少WBC（0〜1/HP）、隐血试验（－），细菌培养（－），该患者最可能的诊断是肠易激综合征。而其他疾病（慢性细菌性痢疾、克罗恩病和溃疡性结肠炎）大便均有脓血，慢性细菌性痢疾的粪细菌培养常阳性。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1083","all_num":"1367","types":0,"pname":"内科学"},{"id":"122","name":"女性，26岁。腹胀、腹痛伴低热、盗汗3个月。查体发现腹部移动性浊音阳性。化验血HBsAg（＋）。腹水常规：比重1.023，蛋白定量38g/L，白细胞数610×106/L，其中单个核细胞为80%。 该患者最可能的诊断是：","data":{"A":"肝硬化合并自发性腹膜炎","B":"结核性腹膜炎","C":"肝炎后肝硬化失代偿期","D":"肝癌腹膜转移"},"da_an":"B","typeid":"117","time":"2018-11-17 15:27:47","xiang_jie":"[答案]B\r\n    [解析]该青年女性患者呈慢性病程，腹胀、腹痛伴低热、盗汗，查体发现有腹水。腹水常规为渗出液（比重＞1.018，蛋白定量＞30g/L,白细胞数＞500×106/L），腹水白细胞中以单个核细胞为主（80%）。因此该患者最可能的诊断是结核性腹膜炎。腹水腺苷脱氨酶升高（>40U/L）的检查结果最支持结核性腹膜炎的诊断，该患者的ADA为79.5U/L，因此该检查结果支持上述诊断。血清一腹水白蛋白梯度（SAAG）12g/L支持肝硬化合并自发性腹膜炎的诊断（SAAG＞11g/L）；腹水病理检查见到癌细胞和腹水培养见到来自肠道的革兰阴性菌均不支持结核性腹膜炎的诊断。该患者诊断为结核性腹膜炎，所以最宜选用的治疗是抗结核治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1094","all_num":"1367","types":0,"pname":"内科学"},{"id":"126","name":"女性，26岁。腹胀、腹痛伴低热、盗汗3个月。查体发现腹部移动性浊音阳性。化验血HBsAg（＋）。腹水常规：比重1.023，蛋白定量38g/L，白细胞数610×106/L，其中单个核细胞为80%。下列检查结果支持上述诊断的是：","data":{"A":"腹水腺苷脱氨酶（ADA） 79.5U/L","B":"血清-腹水白蛋白梯度（SAAG） 12g/L","C":"腹水病理检查见到癌细胞","D":"腹水培养见到来自肠道的革兰阴性菌"},"da_an":"A","typeid":"117","time":"2018-11-17 15:28:12","xiang_jie":"[答案]A\t\r\n    [解析]该青年女性患者呈慢性病程，腹胀、腹痛伴低热、盗汗，查体发现有腹水。腹水常规为渗出液（比重＞1.018，蛋白定量＞30g/L,白细胞数＞500×106/L），腹水白细胞中以单个核细胞为主（80%）。因此该患者最可能的诊断是结核性腹膜炎。腹水腺苷脱氨酶升高（>40U/L）的检查结果最支持结核性腹膜炎的诊断，该患者的ADA为79.5U/L，因此该检查结果支持上述诊断。血清一腹水白蛋白梯度（SAAG）12g/L支持肝硬化合并自发性腹膜炎的诊断（SAAG＞11g/L）；腹水病理检查见到癌细胞和腹水培养见到来自肠道的革兰阴性菌均不支持结核性腹膜炎的诊断。该患者诊断为结核性腹膜炎，所以最宜选用的治疗是抗结核治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1133","all_num":"1319","types":0,"pname":"内科学"},{"id":"129","name":"女性，26岁。腹胀、腹痛伴低热、盗汗3个月。查体发现腹部移动性浊音阳性。化验血HBsAg（＋）。腹水常规：比重1.023，蛋白定量38g/L，白细胞数610×106/L，其中单个核细胞为80%。该患者最宜选用的治疗是：","data":{"A":"对症支持治疗","B":"应用广谱抗生素","C":"抗结核治疗","D":"全身联合肿瘤化疗"},"da_an":"C","typeid":"117","time":"2018-11-17 15:28:31","xiang_jie":"[答案]C\r\n    [解析]该青年女性患者呈慢性病程，腹胀、腹痛伴低热、盗汗，查体发现有腹水。腹水常规为渗出液（比重＞1.018，蛋白定量＞30g/L,白细胞数＞500×106/L），腹水白细胞中以单个核细胞为主（80%）。因此该患者最可能的诊断是结核性腹膜炎。腹水腺苷脱氨酶升高（>40U/L）的检查结果最支持结核性腹膜炎的诊断，该患者的ADA为79.5U/L，因此该检查结果支持上述诊断。血清一腹水白蛋白梯度（SAAG）12g/L支持肝硬化合并自发性腹膜炎的诊断（SAAG＞11g/L）；腹水病理检查见到癌细胞和腹水培养见到来自肠道的革兰阴性菌均不支持结核性腹膜炎的诊断。该患者诊断为结核性腹膜炎，所以最宜选用的治疗是抗结核治疗。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1274","all_num":"1297","types":0,"pname":"内科学"},{"id":"134","name":"粪隐血试验阳性，消化道最小出血量应是：","data":{"A":"5ml","B":"10ml","C":"30ml","D":"50ml"},"da_an":"A","typeid":"117","time":"2005-07-01 15:03:16","xiang_jie":"[答案]A\r\n[考点]上消化道出血\r\n[考点还原]（P453）\u201c（二）出血程度的评估和周围循环状态的判断  成人每日消化道出血＞5ml（A对），粪便潜血试验即出现阳性\u201d。\r\n[解析]这是一道记忆型题，粪隐血试验阳性，消化道最小出血量应是5ml。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1162","all_num":"1292","types":0,"pname":"内科学"},{"id":"137","name":"在急性胰腺炎发病过程中起关键作用的酶是：","data":{"A":"淀粉酶","B":"弹力纤维酶","C":"胰蛋白酶","D":"激肽酶"},"da_an":"C","typeid":"117","time":"2005-07-01 15:04:27","xiang_jie":"[答案]C\r\n[考点]急性胰腺炎的发病机制\r\n[考点还原]（七版内科学P470）\u201c首先激活胰蛋白酶原，形成胰蛋白酶（C对），在胰蛋白酶作用下使各种胰消化酶原激活为有生物活性的消化酶\u2026一旦各种消化酶原激活后，其中其主要作用的活化酶有磷脂酶A\u2082、激肽释放酶或胰舒血管素、弹性蛋白酶和脂肪酶\u2026上述消化酶共同作用，造成胰腺实质及邻近组织的病变\u201d。\r\n[解析]急性胰腺炎是由多种病因导致胰腺组织自身消化所致的胰腺水肿、出血及坏死等炎性损伤。正常胰腺分泌的消化酶有两种形式，一种是有活性的酶如脂肪酶、淀粉酶和核糖核酸酶等；另一种是无活性的如胰蛋白酶原等。正常人胰腺腺泡的胰管内含有胰蛋白酶抑制物质，有避免胰蛋白酶原激活后的自身消化作用。急性胰腺炎时，各种原因导致胰腺腺泡内无活性的胰蛋白酶原激活，产生胰腺自身消化而发病.所以在急性胰腺炎发病过程中起关键作用的酶是胰蛋白酶。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"930","all_num":"1311","types":0,"pname":"内科学"},{"id":"140","name":"女性，20岁。误服有机磷农药后半小时家人送来急诊。查体：神志不清，皮肤潮湿多汗，面部肌肉束颤动，瞳孔缩小，双肺布满湿啰音。该患者最可能的中毒程度是：","data":{"A":"轻度","B":"中度","C":"重度","D":"不能确定"},"da_an":"C","typeid":"117","time":"2018-10-18 00:57:25","xiang_jie":"[答案]C\r\n[考点]有机磷农药中毒程度分级\r\n[考点还原]（P886）\u201c（三）急性中毒诊断分级  1.轻度中毒  仅有M样症状，ChE活力70％～50％。2.中度中毒  M样症状加重，出现N样症状，ChE活力50％～30％。3.重度中毒（C对） 具有M、N样症状，并伴有肺水肿、抽搐、昏迷，呼吸肌麻痹和脑水肿，ChE活力30％以下\u201d。\r\n[解析]该青年女性患者误服有机磷农药中毒，已神志不清，有M样症状（皮肤潮湿多汗、瞳孔缩小）、N样症状（面部肌肉束颤动）及肺水肿（双肺布满湿啰音）。临床中毒程度分度：①轻度中毒：以M样症状为主，胆碱酯酶活力70%〜50%；②中度中毒：M样症状加重，出现N样症状，胆碱酯酶活力50%〜30%；③重度中毒：除M、N样症状外，合并肺水肿、抽搐、昏迷、呼吸肌麻痹和脑水肿，胆碱酯酶活力在30%以下。因此该患者最可能的中毒程度是重度。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"902","all_num":"1143","types":0,"pname":"内科学"},{"id":"146","name":"男性，46岁。2年来消瘦、乏力，近5天来发热、嗜睡，1天来不省人事急诊入院，既往患乙型肝炎多年。查体：T 37.5℃，P 86次/分，R 20次/分，BP 120/80mmHg，神志不清，前胸部可见蜘蛛痣，巩膜轻度黄染，颈软，甲状腺不大，心肺检查未见异常，腹平软，肝肋下未及，脾肋下4cm，移动性浊音阳性。尿常规无异常，化验Hb 110g/L.WBC 3.4×109/L，Plt 92×109/L。 该患者最可能的诊断是：","data":{"A":"肺性脑病","B":"肝性脑病","C":"尿毒症昏迷","D":"脑血管意外"},"da_an":"B","typeid":"117","time":"2005-07-01 15:07:45","xiang_jie":"[答案]B\t\r\n[考点]肝性脑病的诊断和治疗\r\n    [考点还原]（P421）\u201c（二）失代偿期\u20261.肝功能减退\u2026（2）营养不良：一般情况较差，消瘦、乏力，精神不振\u2026（3）黄疸：皮肤、巩膜黄染，尿色深\u20262.门脉高压\u2026（3）脾功能亢进及脾大\u2026脾功能亢进时，患者外周血象呈白细胞减少、增生性贫血和血小板降低\u201d（P435）\u201c【临床表现】 主要表现为高级神经中枢的功能紊乱（如性格改变、智力下降、行为失常、意识障碍等）\u201d（B对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（D对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（P437）\u201c（四）促进体内氨的代谢\u20263.其它  谷氨酸钠或钾、精氨酸等药物理论上具有降血氨作用\u201d（A对）。\r\n[解析]该中年男性患者慢性病程，患乙型肝炎多年，根据病史（消瘦、乏力，近5天来发热、嗜睡，1天来不省人事）和体征（蜘蛛痣、巩膜黄染、脾大、移动性浊音阳性）符合乙型肝炎肝硬化，并引起肝性脑病，其他引起昏迷的疾病均不符合。为明确肝性脑病的诊断，首选的检查是血氨。因为肝性脑病的发病机制可能是氨中毒，所以应选择的治疗措施是降血氨药物如谷氨酸钾，其余均不是针对该患者的发病机制的治疗措施。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1130","all_num":"1180","types":0,"pname":"内科学"},{"id":"154","name":"男性，46岁。2年来消瘦、乏力，近5天来发热、嗜睡，1天来不省人事急诊入院，既往患乙型肝炎多年。查体：T 37.5℃，P 86次/分，R 20次/分，BP 120/80mmHg，神志不清，前胸部可见蜘蛛痣，巩膜轻度黄染，颈软，甲状腺不大，心肺检查未见异常，腹平软，肝肋下未及，脾肋下4cm，移动性浊音阳性。尿常规无异常，化验Hb 110g/L.WBC 3.4×109/L，Plt 92×109/L。为明确诊断，首选的检查是：","data":{"A":"肝肾功能","B":"动脉血气分析","C":"头颅CT","D":"血氨"},"da_an":"D","typeid":"117","time":"2005-07-01 15:09:32","xiang_jie":"[答案]D \r\n[考点]肝性脑病的诊断和治疗\r\n    [考点还原]（P421）\u201c（二）失代偿期\u20261.肝功能减退\u2026（2）营养不良：一般情况较差，消瘦、乏力，精神不振\u2026（3）黄疸：皮肤、巩膜黄染，尿色深\u20262.门脉高压\u2026（3）脾功能亢进及脾大\u2026脾功能亢进时，患者外周血象呈白细胞减少、增生性贫血和血小板降低\u201d（P435）\u201c【临床表现】 主要表现为高级神经中枢的功能紊乱（如性格改变、智力下降、行为失常、意识障碍等）\u201d（B对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（D对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（P437）\u201c（四）促进体内氨的代谢\u20263.其它  谷氨酸钠或钾、精氨酸等药物理论上具有降血氨作用\u201d（A对）。\r\n[解析]该中年男性患者慢性病程，患乙型肝炎多年，根据病史（消瘦、乏力，近5天来发热、嗜睡，1天来不省人事）和体征（蜘蛛痣、巩膜黄染、脾大、移动性浊音阳性）符合乙型肝炎肝硬化，并引起肝性脑病，其他引起昏迷的疾病均不符合。为明确肝性脑病的诊断，首选的检查是血氨。因为肝性脑病的发病机制可能是氨中毒，所以应选择的治疗措施是降血氨药物如谷氨酸钾，其余均不是针对该患者的发病机制的治疗措施。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1033","all_num":"1140","types":0,"pname":"内科学"},{"id":"159","name":"男性，46岁。2年来消瘦、乏力，近5天来发热、嗜睡，1天来不省人事急诊入院，既往患乙型肝炎多年。查体：T 37.5℃，P 86次/分，R 20次/分，BP 120/80mmHg，神志不清，前胸部可见蜘蛛痣，巩膜轻度黄染，颈软，甲状腺不大，心肺检查未见异常，腹平软，肝肋下未及，脾肋下4cm，移动性浊音阳性。尿常规无异常，化验Hb 110g/L.WBC 3.4×109/L，Plt 92×109/L。针对该患者的发病机制，应选择的治疗措施是：","data":{"A":"降血氨药物如谷氨酸钾","B":"纠正水、电解质紊乱","C":"机械通气","D":"降颅压治疗"},"da_an":"A","typeid":"117","time":"2005-07-01 15:11:31","xiang_jie":"[答案]A\r\n[考点]肝性脑病的诊断和治疗\r\n    [考点还原]（P421）\u201c（二）失代偿期\u20261.肝功能减退\u2026（2）营养不良：一般情况较差，消瘦、乏力，精神不振\u2026（3）黄疸：皮肤、巩膜黄染，尿色深\u20262.门脉高压\u2026（3）脾功能亢进及脾大\u2026脾功能亢进时，患者外周血象呈白细胞减少、增生性贫血和血小板降低\u201d（P435）\u201c【临床表现】 主要表现为高级神经中枢的功能紊乱（如性格改变、智力下降、行为失常、意识障碍等）\u201d（B对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（D对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（P437）\u201c（四）促进体内氨的代谢\u20263.其它  谷氨酸钠或钾、精氨酸等药物理论上具有降血氨作用\u201d（A对）。\r\n[解析]该中年男性患者慢性病程，患乙型肝炎多年，根据病史（消瘦、乏力，近5天来发热、嗜睡，1天来不省人事）和体征（蜘蛛痣、巩膜黄染、脾大、移动性浊音阳性）符合乙型肝炎肝硬化，并引起肝性脑病，其他引起昏迷的疾病均不符合。为明确肝性脑病的诊断，首选的检查是血氨。因为肝性脑病的发病机制可能是氨中毒，所以应选择的治疗措施是降血氨药物如谷氨酸钾，其余均不是针对该患者的发病机制的治疗措施。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1043","all_num":"1114","types":0,"pname":"内科学"},{"id":"165","name":"对早期肝性脑病诊断价值最大的检查结果是：","data":{"A":"定向力障碍","B":"心理智能检查异常","C":"扑翼样震颤","D":"病理征阳性"},"da_an":"B","typeid":"117","time":"2005-07-01 15:13:02","xiang_jie":"[答案]B\r\n[考点]肝性脑病的临床表现和诊断\r\n    [考点还原]（P435）\u201c0期（潜伏期） 又称轻微肝性脑病，无行为、性格异常，无神经系统病理征，脑电图正常，只在心理测试或智力测试时有轻微异常\u201d（B对）。（P435）\u201c1期（前驱期） 轻度性格改变和精神异常，如焦虑、欣快激动、淡漠、睡眠倒错、健忘等，可有扑翼样震颤（D错），脑电图多数正常。此期临床表现不明显，易被忽略\u201d。（P435）\u201c2期（昏迷前期） 嗜睡、行为异常（如衣冠不整或随地大小便）、言语不清、书写障碍及定向力障碍（A错）。有腱反射亢进、肌张力增高、踝阵挛及Babinski征阳性等神经体征（C错），有扑翼样震颤，脑电图有特征性异常\u201d。\r\n[解析]肝性脑病主要表现为高级神经中枢功能紊乱及运动和反射异常，其临床过程分为5期，早期即0期（潜伏期）仅在心理智能检查时有轻微异常。扑翼样震颤出现在1、2、3期；定向力障碍和病理征阳性均出现在2期以后。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"930","all_num":"1138","types":0,"pname":"内科学"},{"id":"173","name":"肝硬化患者发生肝肾综合征时的特点是：","data":{"A":"血BUN升高、血钠升高、尿钠降低","B":"血BUN升高、血钠降低、尿钠升高","C":"血BUN升高、血钠降低、尿钠降低","D":"血BUN降低、血钠降低、尿钠升高"},"da_an":"C","typeid":"117","time":"2005-07-01 15:14:25","xiang_jie":"[答案]C\r\n[考点]肝硬化并发症（肝肾综合征）\r\n[考点还原]（七版内科学P450） \u201c（六）肝肾综合征\u2026HRS临床表现为自发性少尿或无尿，氮质血症和血肌酐升高，稀释性低钠血症，低尿钠\u201d（C对）。\r\n[解析]肝肾综合征是肝硬化患者的并发症之一，是由于肾皮质血流量和肾小球滤过持续降低引起功能性肾衰竭，其特征为自发性少尿、氮质血症、稀释性低钠血症、低尿钠、尿比重升高，但肾却无重要病理改变。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"843","all_num":"1110","types":0,"pname":"内科学"},{"id":"177","name":"男性，32岁。3个多月来低热、乏力、大便稀、右下腹痛、体重减轻。查体：T 37.6℃,P 84次/分，BP 110/70mmHg，心肺检查未见异常。腹软，右下腹轻压痛，肝脾肋下未触及，肠鸣音活跃。化验血Hb 125g/L,WBC 5.4×109/L,Plt252×109/L，粪常规偶见WBC。结肠镜检查示回盲部肠黏膜充血水肿，横行溃疡形成，肠腔狭窄，大小及形态各异的炎性息肉。最可能的诊断是：","data":{"A":"克罗恩病","B":"阿米巴肉芽肿","C":"结肠癌","D":"肠结核"},"da_an":"D","typeid":"117","time":"2005-07-01 15:15:42","xiang_jie":"[答案]D\r\n[考点]肠结核的诊断\r\n[考点还原]（P379）\u201c（一）腹痛  多位于右下腹或脐周\u201d（P379）\u201c（二）大便习惯改变  溃疡型肠结核常伴腹泻，粪便呈糊状，多无脓血\u201d（P380）\u201c（四）全身症状和肠外结核表现  结核毒血症状多见于溃疡性肠结核，为长期不规则低热、盗汗、消瘦、贫血和乏力\u201d（P380）\u201c（一）实验室  粪便中可见少量脓细胞和红细胞\u201d（P380）\u201c（三）结肠镜  内镜下见回盲部等处黏膜充血、水肿，溃疡形成，大小及形态各异的炎症息肉，肠腔变窄等\u201d（P381）\u201c表4-7-1  肠结核与克罗恩病的鉴别\u201d（D对）。\r\n[解析]该青年男性患者慢性病程，有低热、乏力、大便稀、右下腹痛、体重减轻，查体见右下腹轻压痛，肠鸣音活跃，应高度怀疑肠结核。结肠镜检查见有典型的肠结核特点，即回盲部肠黏膜充血水肿，横行溃疡形成，肠腔狭窄，大小及形态各异的炎性息肉。因此最可能的诊断是肠结核。其余均不符合。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"927","all_num":"1101","types":0,"pname":"内科学"},{"id":"181","name":"男性，26岁。排柏油便2天，加重伴头晕、心慌半天急诊入院。既往无肝病史，近期无服药史。查体：BP 70/40mmHg，心率120次/分，腹平软，无压痛，肝、脾肋下未触及，四肢末梢发凉。 该患者最可能的诊断是：","data":{"A":"急性胃炎","B":"胃癌","C":"十二指肠溃疡","D":"肝硬化食管静脉曲张破裂出血"},"da_an":"C","typeid":"117","time":"2005-07-01 15:17:20","xiang_jie":"[答案]C\t\r\n[考点]十二指肠溃疡出血的诊断和处理\r\n[考点还原]（P369）\u201c【流行病学】\u2026十二指肠溃疡多见于青壮年\u201d（P452）\u201c（一）呕血与黑粪  是上消化道出血的特征性表现，上消化道大量出血后，均有黑粪。出血部位在幽门以上者常用呕血\u2026黑粪呈柏油样，黏稠而发亮\u201d（P453）\u201c（三）失血性周围循环衰竭  急性大量出血由于循环血容量迅速减少而导致周围循环衰竭。表现为头昏、心慌、乏力，突然起立发生晕厥、肢体冷感、心率加快、血压偏低等。严重者呈休克状态\u201d（C对）。（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（C对）。（P454）\u201c（1）胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（A对）。\r\n[解析]该青年男性患者急性病程，排柏油便伴出血引起的头晕、心慌等症状，而且已达到休克状态（血压低，心率快，四肢末梢发凉），该患者为上消化道出血，因为消化性溃疡是上消化道出血最常见的原因，所以考虑该患者最可能的诊断是十二指肠溃疡；因为既往无肝病史，近期无服药史，而且无呕血，所以不支持肝硬化食管静脉曲张破裂出血和急性胃炎，年轻患者急性发病伴严重出血，也不支持胃癌出血。由于该患者已达到休克状态，所以首选的处理是补充血容量。待病情稳定后，为明确诊断，最重要的检查方法是胃镜检查，其余检查方法均不如胃镜检查好。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"820","all_num":"1133","types":0,"pname":"内科学"},{"id":"188","name":"男性，26岁。排柏油便2天，加重伴头晕、心慌半天急诊入院。既往无肝病史，近期无服药史。查体：BP 70/40mmHg，心率120次/分，腹平软，无压痛，肝、脾肋下未触及，四肢末梢发凉。首选的处理是：","data":{"A":"胃镜止血","B":"三腔二囊管压迫止血","C":"补充血容量","D":"急诊手术治疗"},"da_an":"C","typeid":"117","time":"2005-07-01 15:19:06","xiang_jie":"[答案]C\t\r\n[考点]十二指肠溃疡出血的诊断和处理\r\n[考点还原]（P369）\u201c【流行病学】\u2026十二指肠溃疡多见于青壮年\u201d（P452）\u201c（一）呕血与黑粪  是上消化道出血的特征性表现，上消化道大量出血后，均有黑粪。出血部位在幽门以上者常用呕血\u2026黑粪呈柏油样，黏稠而发亮\u201d（P453）\u201c（三）失血性周围循环衰竭  急性大量出血由于循环血容量迅速减少而导致周围循环衰竭。表现为头昏、心慌、乏力，突然起立发生晕厥、肢体冷感、心率加快、血压偏低等。严重者呈休克状态\u201d（C对）。（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（C对）。（P454）\u201c（1）胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（A对）。\r\n[解析]该青年男性患者急性病程，排柏油便伴出血引起的头晕、心慌等症状，而且已达到休克状态（血压低，心率快，四肢末梢发凉），该患者为上消化道出血，因为消化性溃疡是上消化道出血最常见的原因，所以考虑该患者最可能的诊断是十二指肠溃疡；因为既往无肝病史，近期无服药史，而且无呕血，所以不支持肝硬化食管静脉曲张破裂出血和急性胃炎，年轻患者急性发病伴严重出血，也不支持胃癌出血。由于该患者已达到休克状态，所以首选的处理是补充血容量。待病情稳定后，为明确诊断，最重要的检查方法是胃镜检查，其余检查方法均不如胃镜检查好。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"855","all_num":"1089","types":0,"pname":"内科学"},{"id":"195","name":"男性，26岁。排柏油便2天，加重伴头晕、心慌半天急诊入院。既往无肝病史，近期无服药史。查体：BP 70/40mmHg，心率120次/分，腹平软，无压痛，肝、脾肋下未触及，四肢末梢发凉。为明确诊断，最重要的检查方法是：","data":{"A":"稳定后胃镜检查","B":"稳定后X线钡餐检查","C":"腹部B型超声检查","D":"血清CEA测定"},"da_an":"A","typeid":"117","time":"2005-07-01 15:20:43","xiang_jie":"[答案]A\r\n[考点]十二指肠溃疡出血的诊断和处理\r\n[考点还原]（P369）\u201c【流行病学】\u2026十二指肠溃疡多见于青壮年\u201d（P452）\u201c（一）呕血与黑粪  是上消化道出血的特征性表现，上消化道大量出血后，均有黑粪。出血部位在幽门以上者常用呕血\u2026黑粪呈柏油样，黏稠而发亮\u201d（P453）\u201c（三）失血性周围循环衰竭  急性大量出血由于循环血容量迅速减少而导致周围循环衰竭。表现为头昏、心慌、乏力，突然起立发生晕厥、肢体冷感、心率加快、血压偏低等。严重者呈休克状态\u201d（C对）。（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（C对）。（P454）\u201c（1）胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（A对）。\r\n[解析]该青年男性患者急性病程，排柏油便伴出血引起的头晕、心慌等症状，而且已达到休克状态（血压低，心率快，四肢末梢发凉），该患者为上消化道出血，因为消化性溃疡是上消化道出血最常见的原因，所以考虑该患者最可能的诊断是十二指肠溃疡；因为既往无肝病史，近期无服药史，而且无呕血，所以不支持肝硬化食管静脉曲张破裂出血和急性胃炎，年轻患者急性发病伴严重出血，也不支持胃癌出血。由于该患者已达到休克状态，所以首选的处理是补充血容量。待病情稳定后，为明确诊断，最重要的检查方法是胃镜检查，其余检查方法均不如胃镜检查好。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1034","all_num":"1064","types":0,"pname":"内科学"},{"id":"199","name":"与幽门螺杆菌感染无关的疾病是：","data":{"A":"胃炎","B":"胃溃疡","C":"十二指肠溃疡","D":"胃食管反流病"},"da_an":"D","typeid":"117","time":"2005-07-01 15:21:45","xiang_jie":"[答案]D\r\n[考点]幽门螺杆菌感染\r\n[考点还原]（P357）\u201c（一）抗反流屏障结构与功能异常\u2026（二）食管清除作用降低\u2026（三）食管黏膜屏障功能降低\u201d（D对）。（P364）\u201c（一）Hp感染\u201d（A错）。（P369）\u201cHp感染是消化性溃疡的主要病因\u2026十二指肠球部溃疡患者Hp感染率高达90％～100％（C错），胃溃疡为80％～90％\u201d（B错）。\r\n[解析]幽门螺杆菌感染与某些疾病的发病常有明显的关系，如胃炎、胃溃疡、十二指肠溃疡和胃癌等，而胃食管反流病是由于机体抗反流防御机制减弱和反流物对食管黏膜攻击作用的结果，因此与幽门螺杆菌感染无关。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"987","all_num":"1073","types":0,"pname":"内科学"},{"id":"204","name":"下列对诊断肝硬化门脉高压症最有价值的体征是：","data":{"A":"蜘蛛痣","B":"脾肿大","C":"肝质地坚硬","D":"腹壁静脉曲张\t"},"da_an":"D","typeid":"117","time":"2005-07-01 15:22:54","xiang_jie":"[答案]D\r\n[考点]肝硬化门脉高压症的体征\r\n[考点还原]（P421）\u201c1.肝功能减退  蜘蛛痣（A错）及肝掌的出现均与雌激素增多有关\u201d。\r\n[解析]门脉高压症是肝硬化失代偿期最重要的临床表现，肝硬化门脉高压症的体征包括腹壁静脉曲张（门-体侧支循环开放）、脾大、腹水征等，但脾大、腹水征也可以见于肝硬化门脉高压症以外的其他原因，所以对诊断肝硬化门脉高压症最有价值的体征是腹壁静脉曲张。而蜘蛛痣和肝质地坚硬均不属于肝硬化门脉高压症的体征。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"963","all_num":"1041","types":0,"pname":"内科学"},{"id":"208","name":"男性，23岁。间断上腹痛2年，2天来柏油样便6次，今晨呕咖啡样物200ml。无肝病史。静脉输液后下一步诊治措施首选：","data":{"A":"急诊胃镜及镜下止血","B":"急诊上消化道造影","C":"腹部B型超声检查","D":"外科手术"},"da_an":"A","typeid":"117","time":"2005-07-01 15:23:56","xiang_jie":"[答案]A\r\n[考点]消化性溃疡出血的处理\r\n[考点还原]（P452）\u201c（一）呕血和黑粪  是上消化道出血的特征性表现。上消化道大量出血之后，均有黑粪。出血部位在幽门以上者常伴呕血\u2026呕血多棕褐色呈咖啡渣样\u201d（P454）\u201c胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（A对）。\r\n[解析]该青年男性患者有长期慢性上腹痛病史，现有出血（呕血和柏油样便），无肝病史，最可能是属于消化性溃疡出血。静脉输液纠正血容量不足后，下一步诊治措施首选急诊胃镜及镜下止血，既可以明确诊断，又可以治疗出血。而正在活动性出血的情况下不宜行上消化道造影；腹部B型超声检查对诊断和止血治疗均无帮助；在未充分内科保守治疗和诊断尚不太明确的情况下也不宜首选外科手术。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1011","all_num":"1038","types":0,"pname":"内科学"},{"id":"213","name":"男性，50岁。胃溃疡病史10年，近2个月腹痛加重，失去规律，经多种药物治疗无效，体重下降。查体：浅表淋巴结无肿大，腹平软，上腹部有压痛。 就目前资料考虑，最可能的诊断是：","data":{"A":"胃溃疡复发","B":"胃溃疡癌变","C":"合并胃泌素瘤","D":"复合性溃疡"},"da_an":"B","typeid":"117","time":"2005-07-01 15:25:39","xiang_jie":"[答案]B\t\r\n[考点]胃溃疡癌变的诊断和治疗\r\n[考点还原]（十四版实用内科学P1918）\u201c癌变  对中年以上、有长期GU病史、顽固不愈、近来疼痛节律性消失、食欲缺乏、体重明显减轻和粪便隐血试验持续阳性的患者，应在内镜检查中多取活检，除外癌变\u201d（B对）。（P376）\u201c胃镜检查结合黏膜活检，是目前最可靠的诊断手段\u201d（D对）。（P374）\u201c（五）外科手术\u2026但在下列情况时，可考虑手术治疗\u2026瘢痕性幽门梗阻；④胃溃疡疑有癌变\u201d（D对）。\r\n[解析]该中年男性患者有长期慢性胃溃疡病史，近来腹痛加重，失去规律，经多种药物治疗无效，体重下降，最可能的诊断是胃溃疡癌变，其他诊断均不像。为明确诊断，最有意义的检查是胃镜检查，既可以观察胃部病变情况，又可以取病理活检。因为诊断是胃溃疡癌变，所以最佳的处理方法是手术治疗，而胃黏膜保护剂、质子泵抑制剂和根除幽门螺杆菌治疗只是针对胃溃疡复发或复合性溃疡的治疗。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"999","all_num":"1050","types":0,"pname":"内科学"},{"id":"217","name":"男性，50岁。胃溃疡病史10年，近2个月腹痛加重，失去规律，经多种药物治疗无效，体重下降。查体：浅表淋巴结无肿大，腹平软，上腹部有压痛。为明确诊断，最有意义的检查是：","data":{"A":"粪隐血试验","B":"血清胃泌素测定","C":"钡餐造影","D":"胃镜检查"},"da_an":"D","typeid":"117","time":"2005-07-01 15:27:04","xiang_jie":"[答案]D\t\r\n[考点]胃溃疡癌变的诊断和治疗\r\n[考点还原]（十四版实用内科学P1918）\u201c癌变  对中年以上、有长期GU病史、顽固不愈、近来疼痛节律性消失、食欲缺乏、体重明显减轻和粪便隐血试验持续阳性的患者，应在内镜检查中多取活检，除外癌变\u201d（B对）。（P376）\u201c胃镜检查结合黏膜活检，是目前最可靠的诊断手段\u201d（D对）。（P374）\u201c（五）外科手术\u2026但在下列情况时，可考虑手术治疗\u2026瘢痕性幽门梗阻；④胃溃疡疑有癌变\u201d（D对）。\r\n[解析]该中年男性患者有长期慢性胃溃疡病史，近来腹痛加重，失去规律，经多种药物治疗无效，体重下降，最可能的诊断是胃溃疡癌变，其他诊断均不像。为明确诊断，最有意义的检查是胃镜检查，既可以观察胃部病变情况，又可以取病理活检。因为诊断是胃溃疡癌变，所以最佳的处理方法是手术治疗，而胃黏膜保护剂、质子泵抑制剂和根除幽门螺杆菌治疗只是针对胃溃疡复发或复合性溃疡的治疗。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1035","all_num":"1060","types":0,"pname":"内科学"},{"id":"221","name":"男性，50岁。胃溃疡病史10年，近2个月腹痛加重，失去规律，经多种药物治疗无效，体重下降。查体：浅表淋巴结无肿大，腹平软，上腹部有压痛。根据诊断，最佳的处理方法是：","data":{"A":"胃黏膜保护剂治疗","B":"质子泵抑制剂治疗","C":"根除幽门螺杆菌","D":"手术治疗"},"da_an":"D","typeid":"117","time":"2005-07-01 15:28:31","xiang_jie":"[答案]D\r\n[考点]胃溃疡癌变的诊断和治疗\r\n[考点还原]（十四版实用内科学P1918）\u201c癌变  对中年以上、有长期GU病史、顽固不愈、近来疼痛节律性消失、食欲缺乏、体重明显减轻和粪便隐血试验持续阳性的患者，应在内镜检查中多取活检，除外癌变\u201d（B对）。（P376）\u201c胃镜检查结合黏膜活检，是目前最可靠的诊断手段\u201d（D对）。（P374）\u201c（五）外科手术\u2026但在下列情况时，可考虑手术治疗\u2026瘢痕性幽门梗阻；④胃溃疡疑有癌变\u201d（D对）。\r\n[解析]该中年男性患者有长期慢性胃溃疡病史，近来腹痛加重，失去规律，经多种药物治疗无效，体重下降，最可能的诊断是胃溃疡癌变，其他诊断均不像。为明确诊断，最有意义的检查是胃镜检查，既可以观察胃部病变情况，又可以取病理活检。因为诊断是胃溃疡癌变，所以最佳的处理方法是手术治疗，而胃黏膜保护剂、质子泵抑制剂和根除幽门螺杆菌治疗只是针对胃溃疡复发或复合性溃疡的治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1005","all_num":"1068","types":0,"pname":"内科学"},{"id":"224","name":"正在用PPI治疗的溃疡病患者，用下列方法检查幽门螺杆菌（HP）感染时，最不易出现假阴性的是：","data":{"A":"13C尿素呼气试验","B":"快速尿素酶试验","C":"血清学Hp抗体检查","D":"Hp培养"},"da_an":"C","typeid":"117","time":"2018-10-30 17:32:54","xiang_jie":"[答案]C\r\n[考点]幽门螺杆菌（Hp）的检查方法\r\n[考点还原]（七版内科学P390）\u201c（三）幽门螺杆菌检测\u2026检测方法分为侵入性和非侵入性两大类，前者需通过胃镜检查取胃黏膜活组织进行检测，主要包括快速尿素酶试验、组织学检查和幽门螺杆菌培养；后者主要有¹³C或¹\u2074C尿素呼气试验、粪便幽门螺杆菌抗原检测及血清学检查（定性检测血清抗幽门螺杆菌IgG抗体）\u201d。（七版内科学P391）\u201c应注意，近期使用抗生素、质子泵抑制剂、铋剂等药物，因有暂时抑制幽门螺杆菌作用，会使上述检查（血清学检查除外）呈假阴性\u201d（C对）。\r\n[解析]13C尿素呼气试验、快速尿素酶试验、血清学Hp抗体检查和Hp培养等均为检查有无Hp感染的常用方法。正在用PPI治疗的溃疡病患者，因可能有暂时抑制Hp的作用，从而使直接检查Hp的方法可能会出现假阴性结果，而只有检查Hp抗体的方法不受影响。13C尿素呼气试验、快速尿素酶试验和Hp培养均为直接检查Hp的方法，所以只有血清学Hp抗体检查的方法最不易出现假阴性。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"798","all_num":"1062","types":0,"pname":"内科学"},{"id":"231","name":"急性有机磷中毒的下列临床表现中，能提示中度中毒的是：","data":{"A":"出汗、流涎","B":"呕吐、腹泻","C":"胸背部肌肉颤动","D":"瞳孔缩小"},"da_an":"C","typeid":"117","time":"2005-07-01 15:31:05","xiang_jie":"[答案]C\r\n[考点]急性有机磷中毒的分级\r\n[考点还原]（P886）\u201c（三）急性中毒诊断分级  1.轻度中毒  仅有M样症状（ABD错），ChE活力70％～50％。2.中度中毒  M样症状加重，出现N样症状（C对），ChE活力50％～30％。3.重度中毒  具有M、N样症状，并伴有肺水肿、抽搐、昏迷，呼吸肌麻痹和脑水肿，ChE活力30％以下\u201d。\r\n[解析]急性有机磷中毒是按照临床表现和血胆碱酯酶活力测定结果进行分级。仅有M样症状（如出汗、流涎、呕吐、腹泻和瞳孔缩小等），血胆碱酯酶活力70%〜50%为轻度中毒；M样症状加重，出现N样症状（如胸背部肌肉颤动），血胆碱酯酶活力50%〜30%为中度中毒；具有M样和N样症状，并伴有肺水肿、抽搐、昏迷、呼吸肌麻痹和脑水肿，血胆碱酯酶活力30%以下为重度中毒。因此急性有机磷中毒的临床表现中，能提示中度中毒的是胸背部肌肉颤动。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"765","all_num":"954","types":0,"pname":"内科学"},{"id":"234","name":"男性，58岁。黑便3天，呕血1天伴头晕、心悸被送入急诊室。既往有\u201c慢性胃病史\u201d，无肝病史。查体：T 36.6℃，P 96次/分，BP 108/70mmHg，意识清楚，面色苍白，巩膜无黄染，心、肺检查未见异常，腹软，未见腹壁静脉曲张，肝、脾肋下未触及，移动性浊音阴性，肠鸣音活跃。化验Hb 85g/L,WBC 4.0×109/L，Plt 122×109/L。此时最重要的处理原则是：","data":{"A":"补充血容量","B":"急诊内镜","C":"肌注止血药","D":"急症手术治疗"},"da_an":"B","typeid":"117","time":"2005-07-01 15:32:25","xiang_jie":"[答案]B\r\n[考点]急性上消化道大出血的处理原则\r\n[考点还原]（P452）\u201c（一）呕血和黑粪  是上消化道出血的特征性表现。上消化道大量出血之后，均有黑粪。出血部位在幽门以上者常伴呕血\u201d（P454）\u201c（1）胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（B对）。\r\n[解析]根据该中年男性患者的现病史，肯定为急性上消化道大出血，结合既往有\u201c慢性胃病史\u201d，考虑以胃出血可能性大。急诊内镜一方面可以明确出血的病因，另一方面还可以给予相应的急诊处理。患者目前血流动力学还比较稳定，不急需补充血容量；而肌注止血药的疗效有限；病因未明，而且尚未经过内科的充分治疗，尚无急症手术治疗的指征。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"818","all_num":"1093","types":0,"pname":"内科学"},{"id":"240","name":"男性，46岁。饮酒后出现中上腹部持续性疼痛24小时，呕吐2次，呕吐物为胃内容物，呕吐后腹痛不缓解，急诊入院。查体：T37.8℃,P106次/分，BP90/60mmHg,心、肺检查未见异常，上腹中偏左有压痛、局部反跳痛和肌紧张，肝、脾触诊不满意，移动性浊音阳性，肠鸣音1~2次/分，下肢无水肿。最可能的诊断是：","data":{"A":"急性胆囊炎","B":"轻症急性胰腺炎","C":"重症急性胰腺炎","D":"消化性溃疡穿孔"},"da_an":"C","typeid":"117","time":"2018-11-17 15:34:01","xiang_jie":"[答案]C\t\r\n[考点还原]（P439）\u201c酒精可促进胰液分泌，当胰管流出道不能充分引流大量胰液时，胰管内压升高，引发腺泡细胞损伤\u201d（八版外科学P484-P485）\u201c1.腹痛  常于饱餐和饮酒后突然发作，腹痛剧烈，多位于左上腹，向左肩及左腰背部放射。3.恶心、呕吐  该症状早期即可出现\u2026呕吐物为胃十二指肠内容物，偶可呈咖啡色。呕吐后腹痛不缓解\u201d（P441）\u201c表4-18-1  重症急性胰腺炎的症状、体征及相应的病理生理改变\u201d（C对）。[考点还原]（P441）\u201c胰源性胸、腹水和胰腺假性囊肿中的淀粉酶常明显升高\u201d（B对）。（P441）\u201c血清淀粉酶、脂肪酶的高低与病情程度无确切关联，部分患者的两种胰酶可不升高\u201d（A错）。（P443）\u201c由于吗啡可增加Oddi括约肌压力，胆碱能受体拮抗剂如阿托品可诱发或加重肠麻痹，故均不宜使用\u201d（D对）。\r\n[解析]该中年男性患者饮酒后出现中上腹部持续性疼痛伴呕吐，呕吐后腹痛不缓解，查体上腹中偏左有压痛，最可能的诊断是急性胰腺炎。因查体上腹中偏左有反跳痛和肌紧张，移动性浊音阳性，所以最可能的诊断是重症急性胰腺炎。为明确诊断，最有价值的检查是抽取腹水进行淀粉酶测定，重症急性胰腺炎的特点是腹水淀粉酶明显升高，而血淀粉酶常减低；腹部B型超声检查对诊断有帮助，但不是最有价值的检查；立位腹平片只是对除外消化性溃疡穿孔有帮助。因为该患者入院时诊断尚未完全肯定，所以入院时不宜选用的治疗是皮下注射吗啡类止痛药，否则可能会贻误诊断，影响下一步的处理。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"790","all_num":"1023","types":0,"pname":"内科学"},{"id":"247","name":"男性，46岁。饮酒后出现中上腹部持续性疼痛24小时，呕吐2次，呕吐物为胃内容物，呕吐后腹痛不缓解，急诊入院。查体：T37.8℃,P106次/分，BP90/60mmHg,心、肺检查未见异常，上腹中偏左有压痛、局部反跳痛和肌紧张，肝、脾触诊不满意，移动性浊音阳性，肠鸣音1~2次/分，下肢无水肿。为明确诊断，最有价值的检查是：","data":{"A":"血淀粉酶测定","B":"腹水淀粉酶测定","C":"腹部B型超声检查","D":"立位腹平片"},"da_an":"B","typeid":"117","time":"2018-11-17 15:34:38","xiang_jie":"[答案]B\t\r\n[考点]重症急性胰腺炎的诊断和治疗\r\n[考点还原]（P439）\u201c酒精可促进胰液分泌，当胰管流出道不能充分引流大量胰液时，胰管内压升高，引发腺泡细胞损伤\u201d（八版外科学P484-P485）\u201c1.腹痛  常于饱餐和饮酒后突然发作，腹痛剧烈，多位于左上腹，向左肩及左腰背部放射。3.恶心、呕吐  该症状早期即可出现\u2026呕吐物为胃十二指肠内容物，偶可呈咖啡色。呕吐后腹痛不缓解\u201d（P441）\u201c表4-18-1  重症急性胰腺炎的症状、体征及相应的病理生理改变\u201d（C对）。[考点还原]（P441）\u201c胰源性胸、腹水和胰腺假性囊肿中的淀粉酶常明显升高\u201d（B对）。（P441）\u201c血清淀粉酶、脂肪酶的高低与病情程度无确切关联，部分患者的两种胰酶可不升高\u201d（A错）。（P443）\u201c由于吗啡可增加Oddi括约肌压力，胆碱能受体拮抗剂如阿托品可诱发或加重肠麻痹，故均不宜使用\u201d（D对）。\r\n[解析]该中年男性患者饮酒后出现中上腹部持续性疼痛伴呕吐，呕吐后腹痛不缓解，查体上腹中偏左有压痛，最可能的诊断是急性胰腺炎。因查体上腹中偏左有反跳痛和肌紧张，移动性浊音阳性，所以最可能的诊断是重症急性胰腺炎。为明确诊断，最有价值的检查是抽取腹水进行淀粉酶测定，重症急性胰腺炎的特点是腹水淀粉酶明显升高，而血淀粉酶常减低；腹部B型超声检查对诊断有帮助，但不是最有价值的检查；立位腹平片只是对除外消化性溃疡穿孔有帮助。因为该患者入院时诊断尚未完全肯定，所以入院时不宜选用的治疗是皮下注射吗啡类止痛药，否则可能会贻误诊断，影响下一步的处理。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"694","all_num":"1029","types":0,"pname":"内科学"},{"id":"253","name":"男性，46岁。饮酒后出现中上腹部持续性疼痛24小时，呕吐2次，呕吐物为胃内容物，呕吐后腹痛不缓解，急诊入院。查体：T37.8℃,P106次/分，BP90/60mmHg,心、肺检查未见异常，上腹中偏左有压痛、局部反跳痛和肌紧张，肝、脾触诊不满意，移动性浊音阳性，肠鸣音1?2次/分，下肢无水肿。该患者入院时最不宜选用的治疗是：","data":{"A":"禁食、补液","B":"静脉给予抑制胃酸分泌药","C":"静脉给予抗生素","D":"皮下注射吗啡类止痛药"},"da_an":"D","typeid":"117","time":"2018-11-17 15:36:00","xiang_jie":"[答案]D\r\n[解析]该中年男性患者饮酒后出现中上腹部持续性疼痛伴呕吐，呕吐后腹痛不缓解，查体上腹中偏左有压痛，最可能的诊断是急性胰腺炎。因查体上腹中偏左有反跳痛和肌紧张，移动性浊音阳性，所以最可能的诊断是重症急性胰腺炎。为明确诊断，最有价值的检查是抽取腹水进行淀粉酶测定，重症急性胰腺炎的特点是腹水淀粉酶明显升高，而血淀粉酶常减低；腹部B型超声检查对诊断有帮助，但不是最有价值的检查；立位腹平片只是对除外消化性溃疡穿孔有帮助。因为该患者入院时诊断尚未完全肯定，所以入院时不宜选用的治疗是皮下注射吗啡类止痛药，否则可能会贻误诊断，影响下一步的处理。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"885","all_num":"951","types":0,"pname":"内科学"},{"id":"259","name":"下列关于胃食管反流病胸痛的叙述，错误的是：","data":{"A":"反流物刺激食管痉挛所致","B":"疼痛可发生在胸骨后","C":"疼痛不向他处放射","D":"疼痛可为剧烈刺痛"},"da_an":"C","typeid":"117","time":"2005-07-01 15:38:28","xiang_jie":"[答案]C\r\n[考点]胃食管反流病的临床表现特点\r\n[考点还原]（P357）\u201c胸痛由反流物刺激食管引起（A对），发生在胸骨后（B对）。严重时可为剧烈刺痛（D对），可放射到后背、胸部、肩部、颈部、耳后（C错，为本题正确答案）\u201d。\r\n[解析]胃食管反流病是指胃十二指肠内容物反流入食管引起的一系列症状。其中胸痛是该病的非典型症状，是由反流物刺激食管痉挛所致，疼痛可发生在胸骨后，疼痛可为剧烈刺痛，疼痛可放射到后背、胸部、肩部、颈部、耳后等部位，有时酷似心绞痛。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"888","all_num":"976","types":0,"pname":"内科学"},{"id":"264","name":"下列属于肝硬化肝肾综合征诊断标准的是：","data":{"A":"肝硬化不合并腹水","B":"有休克","C":"近期未使用肾毒性药物","D":"血肌酐大于123μmol/L"},"da_an":"C","typeid":"117","time":"2005-07-01 15:39:36","xiang_jie":"[答案]C\r\n[考点]肝硬化肝肾综合征的诊断标准\r\n[考点还原]（P424）\u201c（六）肝肾综合征\u2026肝肾综合征的诊断标准：①肝硬化合并腹水（A错）；②急进型血清肌酐浓度在2周内升至2倍基线值，或＞226μmol/L（25mg/L），缓进型血清肌酐＞133μmol/L（15mg/L）（D错）；③停利尿剂至少2天以上并经白蛋白扩容后，血肌酐值没有改善。④排除休克（B错）；⑤目前或近期没有用肾毒性药物或扩血管药物治疗（C对）；⑥排除肾实质性疾病\u201d。\r\n[解析]美国肝病学会于2007年推荐发生在肝硬化基础上肝肾综合征诊断的标准是：①肝硬化合并腹水；②无休克；③血肌酐大于133μmol/L；④近期未使用肾毒性药物等。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"732","all_num":"931","types":0,"pname":"内科学"},{"id":"268","name":"患者，男，40岁。8小时前开始上腹剧烈疼痛。查体：上腹部有压痛。此时对确诊价值不大的检查是：","data":{"A":"血淀粉酶","B":"尿淀粉酶","C":"心电图","D":"X线腹部平片"},"da_an":"B","typeid":"117","time":"2005-07-01 15:40:42","xiang_jie":"[答案]B\r\n[考点]急性胰腺炎的诊断\r\n[考点还原]（七版内科学P472）\u201c尿淀粉酶（B对）升高较晚，在发病后12～72小时开始升高，持续7～10天，对病后就诊较晚的急性胰腺炎患者有诊断价值，且特异性也较高\u201d。\r\n[解析]根据该中年男性的病史，首先考虑为急性胰腺炎，血淀粉酶在起病后6〜12小时开始上升，48小时开始下降，所以检查血淀粉酶有确诊价值。为除外急性心肌梗死和急腹症，心电图和X线腹部平片检查也很有意义。而在急性胰腺炎时，尿淀粉酶在起病后12〜14小时才开始上升，而该患者刚起病8小时，所以检查尿淀粉酶的确诊价值不大。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"710","all_num":"998","types":0,"pname":"内科学"},{"id":"275","name":"患者，男，35岁。3个月来间断上腹痛，有时夜间痛醒，反酸。1天前黑便1次，无呕血，但腹痛减轻，化验大便隐血强阳性。最可能的诊断是：","data":{"A":"慢性胃炎","B":"胃溃疡","C":"十二指肠溃疡","D":"胃癌"},"da_an":"C","typeid":"117","time":"2005-07-01 15:42:15","xiang_jie":"[答案]C\t\r\n[考点]十二指肠溃疡的诊断\r\n[考点还原]（P371）\u201c消化性溃疡是上消化道出血中最常见的病因，约占所有病因的50％，十二指肠球部溃疡较胃溃疡易发生\u2026轻者表现为黑粪，重者出现呕血。有慢性腹痛者，出血后腹痛可减轻\u201d（C对）。（七版内科学P389）\u201c发作时上腹痛呈节律性，表现为空腹痛即餐后2～4小时或（及）午夜痛，腹痛多为进食或服用抗酸药所缓解，典型节律性表现在DU多见\u201d。（P371）\u201c（一）胃镜及黏膜活检  胃镜是消化性溃疡诊断的首选方法\u201d（A对）。P453）\u201c成人每日消化道出血＞5ml，粪便潜血试验即出现阳性；每日出血量超过50ml可出现黑粪；胃内积血量＞250ml可引起呕血\u201d（B对）。\r\n[解析]该男性的病史中，呈间断上腹痛，夜间痛醒伴反酸，而且于出血后腹痛减轻，均提示为典型的十二指肠溃疡；为了确定诊断，首选的检查是胃镜检查，可给予直接确诊依据。而其他检查方法均不能给予直接的确诊依据。若患者出现黑便，每日出血量最少应超过50ml。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"874","all_num":"925","types":0,"pname":"内科学"},{"id":"281","name":"患者，男，35岁。3个月来间断上腹痛，有时夜间痛醒，反酸。1天前黑便1次，无呕血，但腹痛减轻，化验大便隐血强阳性。为了确定诊断，首选的检查是：","data":{"A":"胃镜检查","B":"钡餐透视","C":"腹部CT","D":"腹部B超"},"da_an":"A","typeid":"117","time":"2005-07-01 15:43:39","xiang_jie":"[答案]A\t\r\n[考点]十二指肠溃疡的诊断\r\n[考点还原]（P371）\u201c消化性溃疡是上消化道出血中最常见的病因，约占所有病因的50％，十二指肠球部溃疡较胃溃疡易发生\u2026轻者表现为黑粪，重者出现呕血。有慢性腹痛者，出血后腹痛可减轻\u201d（C对）。（七版内科学P389）\u201c发作时上腹痛呈节律性，表现为空腹痛即餐后2～4小时或（及）午夜痛，腹痛多为进食或服用抗酸药所缓解，典型节律性表现在DU多见\u201d。（P371）\u201c（一）胃镜及黏膜活检  胃镜是消化性溃疡诊断的首选方法\u201d（A对）。P453）\u201c成人每日消化道出血＞5ml，粪便潜血试验即出现阳性；每日出血量超过50ml可出现黑粪；胃内积血量＞250ml可引起呕血\u201d（B对）。\r\n[解析]该男性的病史中，呈间断上腹痛，夜间痛醒伴反酸，而且于出血后腹痛减轻，均提示为典型的十二指肠溃疡；为了确定诊断，首选的检查是胃镜检查，可给予直接确诊依据。而其他检查方法均不能给予直接的确诊依据。若患者出现黑便，每日出血量最少应超过50ml。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"883","all_num":"897","types":0,"pname":"内科学"},{"id":"285","name":"患者，男，35岁。3个月来间断上腹痛，有时夜间痛醒，反酸。1天前黑便1次，无呕血，但腹痛减轻，化验大便隐血强阳性。若患者出现黑便，每日出血量最少应超过：","data":{"A":"30ml","B":"50ml","C":"150ml","D":"300ml"},"da_an":"B","typeid":"117","time":"2005-07-01 15:44:53","xiang_jie":"[答案]B\r\n[考点]十二指肠溃疡的诊断\r\n[考点还原]（P371）\u201c消化性溃疡是上消化道出血中最常见的病因，约占所有病因的50％，十二指肠球部溃疡较胃溃疡易发生\u2026轻者表现为黑粪，重者出现呕血。有慢性腹痛者，出血后腹痛可减轻\u201d（C对）。（七版内科学P389）\u201c发作时上腹痛呈节律性，表现为空腹痛即餐后2～4小时或（及）午夜痛，腹痛多为进食或服用抗酸药所缓解，典型节律性表现在DU多见\u201d。（P371）\u201c（一）胃镜及黏膜活检  胃镜是消化性溃疡诊断的首选方法\u201d（A对）。P453）\u201c成人每日消化道出血＞5ml，粪便潜血试验即出现阳性；每日出血量超过50ml可出现黑粪；胃内积血量＞250ml可引起呕血\u201d（B对）。\r\n[解析]该男性的病史中，呈间断上腹痛，夜间痛醒伴反酸，而且于出血后腹痛减轻，均提示为典型的十二指肠溃疡；为了确定诊断，首选的检查是胃镜检查，可给予直接确诊依据。而其他检查方法均不能给予直接的确诊依据。若患者出现黑便，每日出血量最少应超过50ml。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"849","all_num":"897","types":0,"pname":"内科学"},{"id":"290","name":"预防非甾体抗炎药所致消化性溃疡的首选药物是：","data":{"A":"硫糖铝","B":"胶体铋","C":"米索前列醇","D":"阿莫西林"},"da_an":"C","typeid":"117","time":"2005-07-01 15:46:05","xiang_jie":"[答案]C\r\n[考点]消化性溃疡的预防\r\n    [考点还原]（七版内科学P393）\u201c2.保护胃黏膜药物\u2026米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用，主要用于NSAID溃疡的预防\u201d（C对）。\r\n[解析]非甾体抗炎药是致消化性溃疡的重要原因之一，通过抑制环氧化酶（COX）导致胃肠黏膜生理性前列腺素E合成不足，促进胃酸分泌引起消化性溃疡。米索前列醇是临床合成的前列腺素E的衍生物，故有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用，主要用于预防非甾体抗炎药所致消化性溃疡。因此答案是C。而硫糖铝和胶体铋虽然也是保护胃黏膜药物，但目前已较少使用，阿莫西林是抗生素，不用于预防非甾体抗炎药所致消化性溃疡。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"775","all_num":"904","types":0,"pname":"内科学"},{"id":"295","name":"下列关于肝肾综合征临床特点的叙述中，错误的是：","data":{"A":"自发性少尿或无尿","B":"血肌酐升高","C":"血钠升高","D":"尿钠降低"},"da_an":"C","typeid":"117","time":"2005-07-01 15:47:09","xiang_jie":"[答案]C\r\n[考点]肝肾综合征的临床表现\r\n[考点还原]（七版内科学P450）\u201c肝肾综合征 \u2026HRS临床表现为自发性少尿或无尿（A对），氮质血症和血肌酐升高（B对），稀释性低钠血症（C错，为本题正确答案），低尿钠（D对）\u201d。\r\n[解析]肝肾综合征是在严重肝病基础上发生的肾衰竭。发病机制主要是全身血流动力学的改变，使肾小球滤过率下降，所以其临床表现是自发性少尿或无尿、血肌酐升高、稀释性低血钠和尿钠降低。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"831","all_num":"888","types":0,"pname":"内科学"},{"id":"300","name":"女性，32岁，反复发作腹泻3年，伴便前腹痛，便后缓解，体重无变化。近3个月来由于变换工作不顺利等原因，上述症状加重，每日大便5~6次，有黏液，无脓血，使用抗生素治疗效果欠佳。最可能的诊断是：","data":{"A":"肠易激综合征","B":"感染性腹泻","C":"炎症性肠病","D":"抗生素相关性腹泻"},"da_an":"A","typeid":"117","time":"2018-09-12 18:23:23","xiang_jie":"[答案]A\r\n\r\n[考点]肠易激综合征的诊断\r\n\r\n[考点还原]（P400）\u201c【临床表现】 起病隐匿，症状反复发作或慢性迁延，病程可长达数年至数十年，但全身健康状况却不受影响。精神、饮食等因素常诱使症状复发或加重。最主要的临床表现是腹痛或腹部不适、排便习惯和粪便性状的改变\u2026几乎所有的IBS患者均有不同程度的腹痛或腹部不适，部位不定，以下腹和左下腹多见，排便或排气后缓解\u2026腹泻型IBS常排便较急，粪便呈糊状或稀水样，一般每日3～5次左右，少数严重发作期可达十余次，可带有黏液，但无脓血\u201d（A对）。\r\n\r\n[解析]该中年女性","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"867","all_num":"880","types":0,"pname":"内科学"},{"id":"303","name":"男性，55岁，2天前酒后出现上腹痛，进行性加重，并向腰背部放散，曾呕吐1次，为胃内容物，呕吐后腹痛未减轻，稀便2次。既往有\u201c胆石症\u201d病史10年，无高血压、糖尿病病史。查体：体温37.3℃，脉搏80次/分，呼吸20次/分，血压120/80mmHg，巩膜无黄染，心肺未见异常，腹平软，上腹部轻压痛，肝脾肋下未触及。对该患者最可能的诊断是：","data":{"A":"急性胃肠炎","B":"急性胆囊炎","C":"十二指肠球后溃疡","D":"急性胰腺炎"},"da_an":"D","typeid":"117","time":"2005-07-01 15:49:47","xiang_jie":"[考点还原]（P439）\u201c（一）胆道疾病  胆石症及胆道感染等是急性胰腺炎的主要病因\u2026（二）酒精\u2026应注意酒精常与胆道疾病共同导致急性胰腺炎\u201d（八版外科学P484-P485）\u201c1.腹痛  常于饱餐和饮酒后突然发作，腹痛剧烈，多位于左上腹，向左肩及左腰背部放射\u20263.恶心、呕吐  该症状早期即可出现\u2026呕吐物为胃十二指肠内容物，偶可呈咖啡色。呕吐后腹痛不缓解\u201d（D对）。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"817","all_num":"872","types":0,"pname":"内科学"},{"id":"311","name":"男性，55岁，2天前酒后出现上腹痛，进行性加重，并向腰背部放散，曾呕吐1次，为胃内容物，呕吐后腹痛未减轻，稀便2次。既往有\u201c胆石症\u201d病史10年，无高血压、糖尿病病史。查体：体温37.3℃，脉搏80次/分，呼吸20次/分，血压120/80mmHg，巩膜无黄染，心肺未见异常，腹平软，上腹部轻压痛，肝脾肋下未触及。为明确诊断，应首先进行的检查是：","data":{"A":"血、尿淀粉酶","B":"便常规和隐血","C":"腹部CT","D":"胃镜"},"da_an":"A","typeid":"117","time":"2005-07-01 15:52:18","xiang_jie":"[考点还原]（P441）\u201c（一）诊断急性胰腺炎的重要标志物  1.淀粉酶  急性胰腺炎时，血清淀粉酶于起病后2～12小时开始升高，48小时开始下降，持续3～5天\u20262.脂肪酶\u201d（A对）。[答案]A\t\r\n[考点]急性胰腺炎的诊断和治疗\r\n[解析]该中年男性患者酒后急性上腹痛，进行性加重，向腰背部放散，呕吐后腹痛未减轻，既往有\u201c胆石症\u201d病史，上腹有压痛等，为典型的急性胰腺炎的临床表现。急性胃肠炎、急性胆囊炎和十二指肠球后溃疡虽然均有上腹痛，但都不像；发病2天的急性胰腺炎，为明确诊断，应首先进行的检查是血、尿淀粉酶测定，因为血清淀粉酶在起病6〜12小时开始升高，48小时开始下降，持续3〜5天，尿淀粉酶在起病12〜14小时开始升高，持续1〜2周；急性胰腺炎最基本的治疗是禁食补液，以减少胰腺的分泌，该患者最可能是急性水肿型胰腺炎，禁食补液更是最基本的治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"794","all_num":"873","types":0,"pname":"内科学"},{"id":"316","name":"男性，55岁，2天前酒后出现上腹痛，进行性加重，并向腰背部放散，曾呕吐1次，为胃内容物，呕吐后腹痛未减轻，稀便2次。既往有\u201c胆石症\u201d病史10年，无高血压、糖尿病病史。查体：体温37.3℃，脉搏80次/分，呼吸20次/分，血压120/80mmHg，巩膜无黄染，心肺未见异常，腹平软，上腹部轻压痛，肝脾肋下未触及。对该患者最基本的治疗是：","data":{"A":"解痉止痛","B":"禁食补液","C":"抑制胃酸","D":"静脉注射抗生素"},"da_an":"B","typeid":"117","time":"2005-07-01 15:53:57","xiang_jie":"[考点还原]（P443）\u201c1.液体复苏  旨在迅速纠正组织缺氧，也是维持血容量及水、电解质平衡的重要措施\u201d（P443）\u201c（三）减少胰液分泌  1.禁食  食物是胰液分泌的天然刺激物，起病后短期禁食，降低胰液分泌，减轻自身消化\u201d（B对）。[答案]B\r\n[考点]急性胰腺炎的诊断和治疗\r\n[解析]该中年男性患者酒后急性上腹痛，进行性加重，向腰背部放散，呕吐后腹痛未减轻，既往有\u201c胆石症\u201d病史，上腹有压痛等，为典型的急性胰腺炎的临床表现。急性胃肠炎、急性胆囊炎和十二指肠球后溃疡虽然均有上腹痛，但都不像；发病2天的急性胰腺炎，为明确诊断，应首先进行的检查是血、尿淀粉酶测定，因为血清淀粉酶在起病6〜12小时开始升高，48小时开始下降，持续3〜5天，尿淀粉酶在起病12〜14小时开始升高，持续1〜2周；急性胰腺炎最基本的治疗是禁食补液，以减少胰腺的分泌，该患者最可能是急性水肿型胰腺炎，禁食补液更是最基本的治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"796","all_num":"853","types":0,"pname":"内科学"},{"id":"322","name":"引起肠易激综合征发病的最重要因素是：","data":{"A":"急性肠道感染","B":"精神心理障碍","C":"内脏感知异常","D":"对某些食物不耐受"},"da_an":"B","typeid":"117","time":"2005-07-01 15:55:14","xiang_jie":"[答案]B\r\n[考点]肠易激综合征的病因\r\n[考点还原]（P399）\u201c【病因和发病机制】\u2026⑤精神心理障碍：大量调查表明，IBS患者焦虑、抑郁积分显著高于正常人，应激事件发生频率亦高于正常人，对应激反应更敏感和强烈\u201d（B对）。\r\n[解析]肠易激综合征（IBS）是一种功能性肠病。IBS的病因和发病机制尚不清楚，可能与多种因素有关，题中的四个选项均为IBS的发病因素，但只有精神心理障碍是最重要的因素，因为IBS患者存在个性异常，焦虑、抑郁积分显著高于正常人，应激事件发生频率亦高于正常人，所以答案是B。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"839","all_num":"860","types":0,"pname":"内科学"},{"id":"326","name":"下列关于溃疡性结肠炎的肠外表现中，随肠炎控制或结肠切除后可以缓解或恢复的是：","data":{"A":"淀粉样变性","B":"强直性脊柱炎","C":"外周关节炎","D":"骶髂关节炎"},"da_an":"C","typeid":"117","time":"2005-07-01 15:56:19","xiang_jie":"[答案]C\r\n[考点]溃疡性结肠炎的临床表现\r\n[考点还原]（P386）\u201c（三）肠外表现  包括外周关节炎（C对）、结节性红斑、坏疽性脓皮病、巩膜外层炎、前葡萄膜炎、口腔复发性溃疡等，这些肠外表现在结肠炎控制或结肠切除后可以缓解或恢复；骶髂关节炎（D错）、强直性脊柱炎（B错）、原发性硬化性胆管炎及少见的淀粉样变性（A错）、急性发热性嗜中性皮肤病等，可与UC共存，但与UC本身的病情变化无关\u201d。\r\n[解析]溃疡性结肠炎的肠外表现分为两类，一类是随肠炎控制或结肠切除后可以缓解或恢复的，如外周关节炎、结节性红斑、坏死性脓皮病、前葡萄膜炎、巩膜外层炎、口腔复发性溃疡等；另一类是与溃疡性结肠炎共存，但与溃疡性结肠炎本身的病情变化无关，如淀粉样变性、强直性脊柱炎、骶髂关节炎、原发性硬化性胆管炎等。所以随肠炎控制或结肠切除后可以缓解或恢复的是外周关节炎。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"761","all_num":"870","types":0,"pname":"内科学"},{"id":"330","name":"患者，男，54岁。患肝炎后肝硬化10年，近1周来病情加重，腹水量增加，腹胀明显，并出现呼吸困难、睡眠障碍和意识错乱。为减少腹水，下列最佳的治疗药物是：","data":{"A":"阿米洛利","B":"氢氯噻嗪","C":"螺内酯","D":"呋塞米"},"da_an":"C","typeid":"117","time":"2005-07-01 15:57:23","xiang_jie":"[答案]C\r\n[考点]肝硬化腹水的治疗\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]该中年患者患肝炎后肝硬化伴大量腹水，目前已有肝性脑病和因大量腹水引起的呼吸困难的表现。肝硬化腹水的形成与激活肾素-血管紧张素-醛固酮系统有关，螺内酯可通过拮抗醛固酮而发挥利尿作用，而且作用缓和，短期应用不易产生水、电解质紊乱，而其他三种利尿药物作用机制不同，利尿作用强，易引起水、电解质紊乱，并有导致肝性脑病和肝肾综合征的危险。所以最佳的治疗药物是螺内酯。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"738","all_num":"875","types":0,"pname":"内科学"},{"id":"337","name":"患者，女，45岁。反复发作脓血便十余年，此期间有时伴膝关节疼痛，多次大便细菌培养阴性，X线钡剂检查见乙状结肠袋消失，肠壁变硬，肠管变细。 最可能的诊断是：","data":{"A":"溃疡性结肠炎","B":"克罗恩病","C":"肠结核","D":"慢性细菌性痢疾"},"da_an":"A","typeid":"117","time":"2005-07-01 15:59:17","xiang_jie":"[考点还原]（P386）\u201c（一）消化系统表现  1.腹泻和黏液脓血便  见于绝大多数患者\u201d（P386）\u201c（三）肠外表现  包括外周关节炎\u2026\u201d（P387）\u201c（五）X线钡剂灌肠\u2026肠管缩短，结肠袋消失，肠壁变硬，可呈铅管状\u201d（A对）[答案]A\t\r\n[考点]溃疡性结肠炎的临床表现、诊断、并发症\r\n[解析]这是一道临床应用题。该例中年女性患者，有多年慢性脓血便史，但多次大便细菌培养阴性，不支持慢性细菌性痢疾。X线钡剂检查示病变在乙状结肠，而克罗恩病和肠结核的病变主要位于回盲部，而非乙状结肠，所以最可能的诊断是溃疡性结肠炎。因为溃疡性结肠炎的病变部位在乙状结肠，所以腹痛的特点应该是腹痛\u2014便意\u2014便后缓解，腹痛与进食一般无关；溃疡性结肠炎有多种并发症，其中最严重的是中毒性巨结肠，多发生在暴发型或重症溃疡性结肠炎，该患者病史已十余年，X线钡剂检查见乙状结肠肠壁已变硬，肠管变细，所以该患者最不可能出现的并发症是中毒性巨结肠。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"827","all_num":"880","types":0,"pname":"内科学"},{"id":"344","name":"患者，女，45岁。反复发作脓血便十余年，此期间有时伴膝关节疼痛，多次大便细菌培养阴性，X线钡剂检查见乙状结肠袋消失，肠壁变硬，肠管变细。该病腹痛的特点是：","data":{"A":"腹痛\u2014进食\u2014缓解","B":"腹痛\u2014进食\u2014加重","C":"腹痛\u2014便意\u2014便后缓解","D":"腹痛\u2014便意\u2014便后无变化"},"da_an":"C","typeid":"117","time":"2005-07-01 16:00:58","xiang_jie":"[考点还原]（P386）\u201c常有里急后重，便后腹痛缓解\u201d（C对）。[答案]C\t\r\n[考点]溃疡性结肠炎的临床表现、诊断、并发症\r\n[解析]这是一道临床应用题。该例中年女性患者，有多年慢性脓血便史，但多次大便细菌培养阴性，不支持慢性细菌性痢疾。X线钡剂检查示病变在乙状结肠，而克罗恩病和肠结核的病变主要位于回盲部，而非乙状结肠，所以最可能的诊断是溃疡性结肠炎。因为溃疡性结肠炎的病变部位在乙状结肠，所以腹痛的特点应该是腹痛\u2014便意\u2014便后缓解，腹痛与进食一般无关；溃疡性结肠炎有多种并发症，其中最严重的是中毒性巨结肠，多发生在暴发型或重症溃疡性结肠炎，该患者病史已十余年，X线钡剂检查见乙状结肠肠壁已变硬，肠管变细，所以该患者最不可能出现的并发症是中毒性巨结肠。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"827","all_num":"873","types":0,"pname":"内科学"},{"id":"348","name":"患者，女，45岁。反复发作脓血便十余年，此期间有时伴膝关节疼痛，多次大便细菌培养阴性，X线钡剂检查见乙状结肠袋消失，肠壁变硬，肠管变细。该患者最不可能出现的并发症是：","data":{"A":"中毒性巨结肠","B":"癌变","C":"肠出血","D":"肠梗阻"},"da_an":"A","typeid":"117","time":"2005-07-01 16:02:26","xiang_jie":"[考点还原]  八版内科学未明确说明。[答案]A\r\n[考点]溃疡性结肠炎的临床表现、诊断、并发症\r\n[解析]这是一道临床应用题。该例中年女性患者，有多年慢性脓血便史，但多次大便细菌培养阴性，不支持慢性细菌性痢疾。X线钡剂检查示病变在乙状结肠，而克罗恩病和肠结核的病变主要位于回盲部，而非乙状结肠，所以最可能的诊断是溃疡性结肠炎。因为溃疡性结肠炎的病变部位在乙状结肠，所以腹痛的特点应该是腹痛\u2014便意\u2014便后缓解，腹痛与进食一般无关；溃疡性结肠炎有多种并发症，其中最严重的是中毒性巨结肠，多发生在暴发型或重症溃疡性结肠炎，该患者病史已十余年，X线钡剂检查见乙状结肠肠壁已变硬，肠管变细，所以该患者最不可能出现的并发症是中毒性巨结肠。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"587","all_num":"905","types":0,"pname":"内科学"},{"id":"352","name":"下列选项中，不支持有活动性消化道出血的临床表现是：","data":{"A":"贫血","B":"肠鸣音减弱","C":"白细胞增高","D":"血尿素氮增高\t"},"da_an":"B","typeid":"117","time":"2005-07-01 16:03:29","xiang_jie":"[答案]B\r\n[考点]活动性消化道出血的临床表现\r\n[考点还原]（P453-P454）\u201c（三）判断出血是否停止  下列情况应考虑有消化道活动出血：①反复呕血或黑粪（血便）次数增多、粪质稀薄，伴有肠鸣音活跃（B对）；②周围循环状态经充分补液及输血后未见明显改善，或虽暂时好转而又继续恶化；③血红蛋白浓度（A错）、红细胞计数与血细胞比容继续下降，网织红细胞计数持续增高；④补液与尿量足够的情况下，血尿素氮持续或再次增高（D错）\u201d。\r\n[解析]有活动性消化道出血时，临床上可出现贫血、肠鸣音活跃、白细胞增高和血尿素氮增高，因此不会出现肠鸣音减弱。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"612","all_num":"885","types":0,"pname":"内科学"},{"id":"359","name":"下列符合中度有机磷中毒时的胆碱酯酶活力是：","data":{"A":"35%","B":"25%","C":"15%","D":"10%"},"da_an":"A","typeid":"117","time":"2005-07-01 16:04:54","xiang_jie":"[答案]A\r\n[考点]有机磷中毒时胆碱酯酶活力检查的临床意义\r\n[考点还原]（P885）\u201c（一）血ChE活力测定\u2026以正常人血ChE活力值作为100％，急性OPI中毒时，ChE活力值在70％～50％为轻度中毒；50％～30％为中度中毒（A对）；30％以下为重度中毒\u201d。\r\n[解析]有机磷中毒时的胆碱酯酶活力变化，对临床判断有机磷中毒的程度很有意义。中度有机磷中毒时的胆碱酯酶活力是50%〜30%,胆碱酯酶活力在30%以下时为重度有机磷中毒，胆碱酯酶活力在50%以上时为轻度有机磷中毒。因此答案是A。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"600","all_num":"764","types":0,"pname":"内科学"},{"id":"363","name":"患者，男，40岁。6小时前大量饮酒后出现持续性上腹疼痛，阵发性加重，向腰背部放射，弯腰抱膝位可减轻。查体：上腹有压痛，轻度肌紧张。最不可能出现的实验室检查结果是：","data":{"A":"血清淀粉酶明显升高","B":"腹水淀粉酶明显升高","C":"血糖升高","D":"血钙降低"},"da_an":"A","typeid":"117","time":"2005-07-01 16:05:54","xiang_jie":"[答案]A\r\n[考点]急性重症胰腺炎的实验室检查\r\n[考点还原]（P440）\u201c（一）轻症急性胰腺炎  急性腹痛，常较剧烈，多位于中左上腹、甚至全腹，部分患者腹痛向背部放射\u2026（二）重症急性胰腺炎  在上述症状基础上，腹痛持续不缓、腹胀加重\u201d（八版外科学P485）\u201c诊断性腹腔穿刺若抽出血性渗出液，其淀粉酶值升高对诊断很有帮助\u201d（P441）\u201c表4-18-2  反映SAP病理生理变化的实验室检测指标\u201d（BCD对）。\r\n[解析]该例中年男性患者，急性起病，持续上腹部疼痛，阵发性加重，向腰背部放射，弯腰抱膝位可减轻，是典型的急性胰腺炎的临床表现，查体发现上腹有压痛和轻度肌紧张，提示为急性重症胰腺炎。一般急性重症胰腺炎时血清淀粉酶常升高不明显，有时甚至降低，而腹水淀粉酶明显升高、血糖升高和血钙降低常是急性重症胰腺炎的实验室检查结果。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"469","all_num":"860","types":0,"pname":"内科学"},{"id":"380","name":"患者，男，45岁。2个月来反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，近1周来加重，有时伴胸骨后疼痛，ECG未见明显异常，内镜检查见食管黏膜破损有融合。对该患者的诊断是：","data":{"A":"胃食管反流病","B":"心绞痛","C":"Mallory-Weiss综合征","D":"食管憩室炎"},"da_an":"A","typeid":"117","time":"2005-07-01 16:11:07","xiang_jie":"[考点还原]（P357）\u201c烧心和反流是本病最常见和典型的症状\u2026烧心和反流常在餐后1小时出现，卧位、弯腰或腹压增高时可加重\u201d（P357）\u201c2.非典型症状  胸痛由反流物刺激食管引起，发生在胸骨后\u201d（P358）\u201c胃镜下RE分级\u2026C级：黏膜破损有融合，但小于75％的食管周径；D级：黏膜破损融合，至少达到75％的食管周径\u201d（A对）。[答案]A\t\r\n[考点]胃食管反流病的诊断和治疗\r\n[解析]该中年男性患者的病史有反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，内镜检查结果发现食管黏膜破损有融合，这些均支持胃食管反流病的诊断。有时伴胸骨后疼痛，虽可支持心绞痛的诊断，但心绞痛的疼痛一般与体位无关。该病例的特点均不支持Mallory-Weiss综合征和食管憩室炎的诊断。胃食管反流病的最佳治疗药物是奥美拉唑，这类药物抑酸作用强，特别适用于症状重、有严重食管炎的患者，若需维持治疗，选用的最佳药物是奥美拉唑，因为此药的效果最好。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"811","all_num":"822","types":0,"pname":"内科学"},{"id":"387","name":"患者，男，45岁。2个月来反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，近1周来加重，有时伴胸骨后疼痛，ECG未见明显异常，内镜检查见食管黏膜破损有融合。选用的最佳治疗药物是：","data":{"A":"多潘立酮","B":"硝酸甘油","C":"氢氧化铝","D":"奥美拉唑"},"da_an":"D","typeid":"117","time":"2005-07-01 16:13:04","xiang_jie":"[考点还原]（P359）\u201c2.抑酸药  对初次接受治疗的患者或有食管炎的患者宜以PPI治疗，以求迅速控制症状、治愈食管炎\u201d（P359）\u201c2.抑酸药  对初次接受治疗的患者或有食管炎的患者宜以PPI治疗，以求迅速控制症状、治愈食管炎\u201d（D对）。[答案]D\t\r\n[考点]胃食管反流病的诊断和治疗\r\n[解析]该中年男性患者的病史有反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，内镜检查结果发现食管黏膜破损有融合，这些均支持胃食管反流病的诊断。有时伴胸骨后疼痛，虽可支持心绞痛的诊断，但心绞痛的疼痛一般与体位无关。该病例的特点均不支持Mallory-Weiss综合征和食管憩室炎的诊断。胃食管反流病的最佳治疗药物是奥美拉唑，这类药物抑酸作用强，特别适用于症状重、有严重食管炎的患者，若需维持治疗，选用的最佳药物是奥美拉唑，因为此药的效果最好。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"785","all_num":"800","types":0,"pname":"内科学"},{"id":"394","name":"患者，男，45岁。2个月来反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，近1周来加重，有时伴胸骨后疼痛，ECG未见明显异常，内镜检查见食管黏膜破损有融合。若需维持治疗，选用的最佳药物是：","data":{"A":"雷尼替丁","B":"奥美拉唑","C":"枸橼酸铋钾","D":"莫沙比利"},"da_an":"B","typeid":"117","time":"2005-07-01 16:14:53","xiang_jie":"[考点还原]（P359）\u201cPPI和H\u2082RA均可用于维持治疗，PPI效果更优\u201d（B对）。[答案]B\r\n[考点]胃食管反流病的诊断和治疗\r\n[解析]该中年男性患者的病史有反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，内镜检查结果发现食管黏膜破损有融合，这些均支持胃食管反流病的诊断。有时伴胸骨后疼痛，虽可支持心绞痛的诊断，但心绞痛的疼痛一般与体位无关。该病例的特点均不支持Mallory-Weiss综合征和食管憩室炎的诊断。胃食管反流病的最佳治疗药物是奥美拉唑，这类药物抑酸作用强，特别适用于症状重、有严重食管炎的患者，若需维持治疗，选用的最佳药物是奥美拉唑，因为此药的效果最好。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"768","all_num":"794","types":0,"pname":"内科学"},{"id":"399","name":"结核性腹膜炎腹痛的特点是：","data":{"A":"早期腹痛明显","B":"呈持续性绞痛","C":"疼痛多位于脐周、下腹","D":"呈转移性疼痛\t"},"da_an":"C","typeid":"117","time":"2005-07-01 16:16:01","xiang_jie":"[答案]C\r\n[考点]结核性腹膜炎腹痛的特点\r\n[考点还原]（P382）\u201c（二）腹痛  位于脐周、下腹或全腹，持续或阵发性隐痛\u201d（C对）。（七版内科学P406）\u201c（二）腹痛  早期腹痛不明显（A错），以后可出现持续性隐痛或钝痛（B错），也可始终没有腹痛。疼痛多位于脐周、下腹（C对），有时在全腹。当并发不完全性肠梗阻时，有阵发性绞痛。偶可表现为急腹症\u201d。\r\n[解析]结核性腹膜炎早期腹痛不明显，以后可呈持续性隐痛或钝痛，疼痛多位于脐周、下腹，不会像阑尾炎那样呈转移性疼痛，因此答案应选C。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"721","all_num":"822","types":0,"pname":"内科学"},{"id":"403","name":"对高度怀疑肠结核的病例中，下列最有利于临床诊断的是：","data":{"A":"抗结核治疗2〜6周有效","B":"PPD试验阳性","C":"有肠外结核","D":"有腹痛、腹泻、右下腹压痛"},"da_an":"A","typeid":"117","time":"2005-07-01 16:16:59","xiang_jie":"[答案]A\r\n[考点]肠结核的诊断\r\n[考点还原]（P380-P381）\u201c对高度怀疑肠结核的病例，如抗结核治疗数周内（2～6周）症状明显改善，2～3个月后肠镜检查病变明显改善或好转，可作出肠结核的临床诊断\u201d（A对）。\r\n[解析]肠结核的诊断依据临床表现特点、X线钡剂检查和结肠镜检查结果，对高度怀疑肠结核的病例中，如抗结核治疗2〜6周有效，可作出肠结核的临床诊断，因此答案应选A。其余三个选项可有利于诊断，但均无确诊意义。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"726","all_num":"827","types":0,"pname":"内科学"},{"id":"409","name":"非甾体抗炎药（NSAID）引起的消化性溃疡，当不能停用NSAID时，首选的治疗药物是：","data":{"A":"雷尼替丁","B":"硫糖铝","C":"西沙必利","D":"奥美拉唑"},"da_an":"D","typeid":"117","time":"2005-07-01 16:18:22","xiang_jie":"[答案]D\r\n[考点]非甾体抗炎药（NSA1D）引起的消化性溃疡的治疗\r\n[考点还原]（七版内科学P394）\u201c（四）NSAID溃疡的治疗、复发预防及初始预防\u2026对不能停用NSAID者，应首选PPI治疗（H\u2082RA疗效差）\u201d（D对）。\r\n[解析]对服用NSAID后出现的溃疡的治疗，如情况允许应立即停用NSAID，对不能停用NSAID者，应首选质子泵抑制剂（PPI）即奥美拉唑治疗，因此答案应选D。而其他药物的疗效均较差，特别是西沙必利仅为胃肠动力药，疗效会更差。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"680","all_num":"828","types":0,"pname":"内科学"},{"id":"414","name":"下列胃食管反流病的临床表现中，不属于食管外刺激症状的是：","data":{"A":"咳嗽","B":"哮喘","C":"胸痛","D":"声嘶"},"da_an":"C","typeid":"117","time":"2005-07-01 16:19:38","xiang_jie":"[答案]C\r\n[考点]胃食管反流病的临床表现\r\n[考点还原]（P357）\u201c（一）食管症状\u20262.非典型症状  胸痛由反流物刺激食管引起，发生于胸骨后\u201d（C错，为本题正确答案）。（P357）\u201c（二）食管外症状  由反流物刺激或损伤食管以外的组织或器官引起，如咽喉炎、慢性咳嗽和哮喘\u201d（AB对）。\r\n[解析]胃食管反流病的临床表现多样，包括反流物刺激食管引起的表现和食管以外的刺激表现，选项中只有胸痛是属于反流物刺激食管引起的表现，而其余三个选项均为食管以外刺激症状，属于食管以外刺激症状的还有咽喉炎和吸入性肺炎的表现等，因此答案应选C。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"673","all_num":"814","types":0,"pname":"内科学"},{"id":"420","name":"男性，35岁，患肠易激综合征5年，近1个月来排便困难，粪便干结，伴失眠、焦虑。下列不宜选用的治疗药物是：","data":{"A":"甲基纤维素","B":"聚乙二醇","C":"洛哌丁胺","D":"阿米替林"},"da_an":"C","typeid":"117","time":"2018-11-20 14:46:52","xiang_jie":"[答案]C\r\n[考点]肠易激综合征（IBS）的治疗\r\n[考点还原]（（P399）\u201c4.抗抑郁药  常用的有三环类抗抑郁药如阿米替林（D对）、选择性5-羟色胺再摄取的抗抑郁药如帕罗西汀等，宜从小剂量开始，注意药物的不良反应\u201d。（P400）\u201c2.止泻药  洛哌丁胺或地芬诺酯止泻效果好，适用于腹泻症状较重者\u201d（C错，为本题正确答案）。（P400）\u201c泻药  对便秘型患者酌情使用泻药，宜使用作用温和的轻泻剂以减少不良反应和药物依赖性。常用的有渗透性轻泻剂如聚乙二醇、乳果糖或山梨醇，容积性泻药如甲基纤维素等也可选用\u201d（AB对）。\r\n[解析]题干中的病人是患便秘型IBS,因而应酌情使用泻药，但不宜选用止泻药，选项中的洛哌丁胺属于止泻药，所以不宜选用。因此答案应选C。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"632","all_num":"816","types":0,"pname":"内科学"},{"id":"425","name":"男性，30岁，腹痛、腹泻、间断低热3年，结肠镜见回肠末段病变呈跳跃性，见纵行溃疡，溃疡周围黏膜呈鹅卵石样。最可能的诊断是：","data":{"A":"溃疡性结肠炎","B":"溃疡型肠结核","C":"肠伤寒","D":"克罗恩病"},"da_an":"D","typeid":"117","time":"2005-07-01 16:21:53","xiang_jie":"[答案]D\r\n[考点]克罗恩病的诊断依据\r\n[考点还原]（P390）\u201c多见于末端回肠和邻近结肠，但从口腔至肛门各段消化道均可受累，呈节段性或跳跃式分布。临床以腹痛、腹泻、体重下降、腹块、瘘管形成和肠梗阻为特点，可伴有发热等全身表现及关节、皮肤、眼、口腔黏膜等肠外损害\u201d（P391）\u201c（三）肠镜检查 \u2026可见阿弗他溃疡或纵行溃疡，黏膜鹅卵石样改变，肠腔狭窄或肠壁僵硬，炎性息肉，病变之间黏膜外观正常，病变呈节段性、非对称性分布\u201d（D对）。\r\n[解析]该病人病史较长（3年），因此肯定不是肠伤寒，而结肠镜发现病变在回肠末段，这也不符合溃疡性结肠炎，因为溃疡性结肠炎的病变多在直肠和乙状结肠。病变部位符合溃疡型肠结核和克罗恩病，但结肠镜所见支持克罗恩病的诊断，因此答案应选D。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"738","all_num":"818","types":0,"pname":"内科学"},{"id":"433","name":"男性，47岁，腹胀、纳差半年，6小时前突然呕血约1000ml来急诊，既往HBsAg（＋）。查体示P 125次/分，BP 70/50mmHg,巩膜轻度黄染，肝脾肋下未触及，移动性浊音（＋），下肢有可凹性水肿。引起呕血的最可能病因是：","data":{"A":"胃癌","B":"肝硬化","C":"消化性溃疡","D":"胆囊结石"},"da_an":"B","typeid":"117","time":"2005-07-01 16:23:37","xiang_jie":"[考点还原]（P419）\u201c乙型肝炎病毒感染为最常见的病因\u201d（P421）\u201c1.肝功能减退  （1）消化吸收不良：食欲减退、恶心、厌食，腹胀\u2026（3）黄疸\u2026（7）低蛋白血症：患者常有下肢水肿及腹水\u201d（P421）\u201c2.门静脉高压\u2026（1）腹水\u201d（P423）\u201c门静脉高压是导致曲张静脉出血的主要原因，诱因多见于粗糙食物、胃酸侵蚀、腹内压增高及剧烈咳嗽等。临床表现为突发大量呕血或柏油样便，伴出血性休克等\u201d（B对）。[答案]B\t\r\n[考点]肝硬化的诊断和处理\r\n[解析]该中年男性病人，有腹胀、纳差病史及HBsAg（＋），最可能是有乙型病毒性肝炎病史，突然大量呕血，查体发现黄疸和腹水，可能原有脾大而因大出血后缩小，所以呕血最可能的病因是肝硬化，由于食管胃底静脉曲张破坏出血，而胃癌、消化性溃疡和胆囊结石的临床表现与上述不同。因为该病人大量呕血已处于早期休克状态，所以首选的处理措施是紧急输血和输液，而其余三个选项均不是首选处理措施。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"766","all_num":"807","types":0,"pname":"内科学"},{"id":"440","name":"男性，47岁，腹胀、纳差半年，6小时前突然呕血约1000ml来急诊，既往HBsAg（＋）。查体示P 125次/分，BP 70/50mmHg,巩膜轻度黄染，肝脾肋下未触及，移动性浊音（＋），下肢有可凹性水肿。应首选的处理措施是：","data":{"A":"急诊胃镜止血","B":"剖腹探查","C":"紧急输血和输液","D":"三腔二囊管压迫"},"da_an":"C","typeid":"117","time":"2005-07-01 16:25:15","xiang_jie":"[考点还原]（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（C对）。[答案]C\r\n[考点]肝硬化的诊断和处理\r\n[解析]该中年男性病人，有腹胀、纳差病史及HBsAg（＋），最可能是有乙型病毒性肝炎病史，突然大量呕血，查体发现黄疸和腹水，可能原有脾大而因大出血后缩小，所以呕血最可能的病因是肝硬化，由于食管胃底静脉曲张破坏出血，而胃癌、消化性溃疡和胆囊结石的临床表现与上述不同。因为该病人大量呕血已处于早期休克状态，所以首选的处理措施是紧急输血和输液，而其余三个选项均不是首选处理措施。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"638","all_num":"825","types":0,"pname":"内科学"},{"id":"444","name":"对肝炎后肝硬化的诊断下列哪项最有价值：","data":{"A":"脾大","B":"蜘蛛痣","C":"肝功能不正常","D":"超声波显示肝回声不均质","E":"食管钡餐检查下段有蚯蚓样充盈缺损"},"da_an":"E","typeid":"117","time":"2005-07-01 16:26:29","xiang_jie":"[答案]E\r\n[考点]肝炎后肝硬化的诊断\r\n[考点还原]  八版内科学未明确说明。\r\n[分析]食管钡餐检查下段有蚯蚓样充盈缺损，提示为肝硬化特有的食管下段静脉曲张的征象，因而对诊断肝硬化最有价值，而其他几项仅提示肝脏可能有病，无特异性诊断价值。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"649","all_num":"821","types":0,"pname":"内科学"},{"id":"448","name":"关于肠结核的临床表现，下列哪项不正确：","data":{"A":"腹泻是溃疡型肠结核的主要临床表现之一","B":"腹部肿块主要见于增生型肠结核","C":"多见于青少年与壮年","D":"多数起病缓慢","E":"多不伴有肺结核"},"da_an":"E","typeid":"117","time":"2005-07-01 16:27:43","xiang_jie":"[答案]E\r\n[考点]肠结核的临床表现\r\n[考点还原]（P379）\u201c肠结核是结核分枝杆菌引起的肠道慢性特异性感染\u201d（D对）。（P379）\u201c90％以上的肠结核主要由人型结核分枝杆菌引起，多因患开放性肺结核或喉结核而吞下含菌痰液、或常与开放性肺结核患者共餐而忽视餐具消毒等而被感染\u201d（E错，为本题正确答案）。（P379）\u201c本病一般见于中青年，女性稍多于男性\u201d（C对）。（P379）\u201c溃疡型肠结核常伴腹泻\u201d（A对）。（P379）\u201c腹部肿块多位于右下腹，质中、较固定、轻至中度压痛。多见于增生型肠结核\u201d（B对）。\r\n[解析]肠结核患者多有开放性肺结核，因经常吞下含结核杆菌的痰液而致病，因而肠结核多不伴有肺结核的提法是不正确的。其他描述的四个临床表现均符合肠结核。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"757","all_num":"810","types":0,"pname":"内科学"},{"id":"459","name":"患者男，50岁，半年来反复出现腹泻，粪便糊样，时有腹泻和便秘交替。检查轻度贫血貌，右下腹部可扪及肿块，胃肠X线检查示回盲部钡剂充盈缺损，考虑最不像哪个病：","data":{"A":"结肠癌","B":"Crohn病","C":"血吸虫病性肉芽肿","D":"肠结核","E":"慢性溃疡性结肠炎"},"da_an":"E","typeid":"117","time":"2005-07-01 16:30:04","xiang_jie":"[答案]E\r\n[考点]消化系统疾病鉴别诊断\r\n[考点还原]（P379）\u201c（二）大便习惯改变  溃疡型肠结核常伴腹泻，粪便呈糊样，多无脓血，不伴里急后重。有时腹泻与便秘交替。（三）腹部肿块  多位于右下腹\u201d（P379）\u201c（四）全身症状和肠外结核表现  结核毒血症状多见于溃疡型肠结核，为长期不规则低热、盗汗、消瘦、贫血和乏力\u201d（D错）。（P391）\u201c2.腹泻  亦为本病常见症状\u2026粪便多为糊状，一般无脓血和黏液。3.腹部包块  多位于右下腹与脐周\u201d（P391）\u201c（二）全身表现  主要表现为体重下降，可有贫血、低蛋白血症和维生素缺乏等表现\u201d（B错）。（P385-P386）\u201c病变多自直肠开始，逆行向近段发展，可累及全结肠甚至末端回肠\u201d（P386）\u201c1.腹泻和黏液脓血便  见于绝大多数患者\u201d（E对）。（P395）\u201c我国发病年龄多在40～60岁，发病高峰在50岁左右\u201d（P395）\u201c也可表现为腹泻与糊状大便，或腹泻与便秘交替，粪质无明显黏液脓血\u201d（P395）\u201c（三）腹部肿块\u201d（P395）\u201c（五）全身情况  可有贫血、低热，多见于右侧结直肠癌\u201d（A错）。\r\n[解析]本例的突出特点是右下腹扪及肿块，X线检查示回盲部钡剂充盈缺损，因此病变常累及右半肠管的结肠癌、Crohn病、血吸虫病性肉芽肿和肠结核均可能性大，而慢性溃疡性结肠炎主要累及直肠、乙状结肠和降结肠，较少累及右半肠管，而且很少有肉芽肿形成，仅偶有假息肉形成，因此最不像。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"561","all_num":"819","types":0,"pname":"内科学"},{"id":"463","name":"患者女，25岁，昨晚吃剩饭一碗，当夜发生上腹痛，持续恶心、呕吐。体温36.5℃，上腹部压痛，肠鸣音活跃。白细胞总数、分类及粪常规正常，首先考虑：","data":{"A":"急性胃炎","B":"急性胰腺炎","C":"胃溃疡","D":"胆囊炎","E":"胃神经官能症"},"da_an":"A","typeid":"117","time":"2005-07-01 16:31:42","xiang_jie":"[答案]A\r\n[考点]消化系统疾病鉴别诊断\r\n[考点还原]（P364）\u201c【临床表现】 常有上腹痛、胀满、恶心、呕吐和食欲不振等\u201d。\r\n[解析]本例患者发病很急，有明确吃剩饭史，表现为胃部症状，不发热，应首先考虑急性胃炎，而急性胰腺炎和胆囊炎可发病急，但常伴发热，白细胞数常增高，本例不支持，胃溃疡和胃神经官能症常有相应病史，本例未提及，故也不首先考虑。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"648","all_num":"789","types":0,"pname":"内科学"},{"id":"467","name":"肝硬化患者在很短时间里出现腹痛和大量血性腹水，不伴有发热，应首先考虑可能并发：","data":{"A":"原发性腹膜炎","B":"继发性肝癌","C":"结核性腹膜炎","D":"肝肾综合征","E":"门静脉血栓形成"},"da_an":"E","typeid":"117","time":"2005-07-01 16:32:57","xiang_jie":"[答案]E\r\n[考点]肝硬化并发症\r\n[考点还原]（P424）\u201c（四）门静脉血栓形成或海绵样变\u2026急性或亚急性发展时，表现为中、重度腹胀痛或突发剧烈腹痛、脾大、顽固性腹水、肠坏死、消化道出血及肝性脑病等，腹穿可抽出血性腹水\u201d（E对）。\r\n[解析]肝硬化患者在很短时间里出现腹痛和大量血性腹水，不伴有发热，应首先考虑可能并发门静脉血栓形成，其他四种情况虽可使腹水加重，但原发性腹膜炎和结核性腹膜炎常伴发热，血性腹水较少，继发性肝癌进展应慢性，不会在很短时间里加重，肝肾综合征较少出现腹痛和血性腹水。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"649","all_num":"754","types":0,"pname":"内科学"},{"id":"470","name":"治疗消化性溃疡时，应用下列何种药物抑制胃酸和胃蛋白酶分泌最有效：","data":{"A":"酸泵抑制剂","B":"H2受体拮抗剂","C":"M胆碱受体阻滞剂","D":"胃泌素受体拮抗剂","E":"胃酸中和剂"},"da_an":"A","typeid":"117","time":"2005-07-01 16:34:14","xiang_jie":"[答案]A\r\n[考点]消化性溃疡的药物治疗\r\n[考点还原]（P372）\u201cPPI使H\u207a-K\u207a-ATP酶失去活性，抑酸作用很强，可使胃内达到无酸水平。由于PPI与H\u207a-K\u207a-ATP酶结合后，其作用是不可逆的\u2026PPI多在2～3天内控制症状，溃疡愈合率略高于H\u2082受体拮抗剂，对一些难治性溃疡的疗效优于H\u2082受体拮抗剂\u201d（A对BCDE错）。\r\n[解析]酸泵抑制剂如奥美拉唑（Ome-prazole）是抑制胃酸和胃蛋白酶分泌最有效的药物，几乎完全抑制胃酸分泌。其他四种药物虽然有效，但均较酸泵抑制剂弱。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"646","all_num":"793","types":0,"pname":"内科学"},{"id":"474","name":"与维生素B12吸收有关的内因子是由胃黏膜中哪种细胞产生的：","data":{"A":"表层柱状上皮","B":"黏液细胞","C":"主细胞","D":"壁细胞","E":"G细胞"},"da_an":"D","typeid":"117","time":"2005-07-01 16:35:53","xiang_jie":"[答案]D\r\n[考点]胃的分泌功能\r\n[考点还原]（P196）\u201c壁细胞在分泌盐酸的同时，也分泌一种被称为内因子的糖蛋白\u201d（D对）。\r\n[解析]这是道记忆题，内因子是由胃黏膜中的壁细胞产生的，其他细胞均不产生内因子，有的则产生其他物质，如G细胞产生胃泌素，主细胞产生胃蛋白酶原，黏液细胞产生碱性黏液。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"668","all_num":"762","types":0,"pname":"内科学"},{"id":"481","name":"误服下列哪种药物中毒应该洗胃：","data":{"A":"石炭酸","B":"醋酸","C":"水杨酸类","D":"硝酸","E":"氯化高汞"},"da_an":"C","typeid":"117","time":"2005-07-01 16:37:28","xiang_jie":"[答案]C\r\n[考点]洗胃的适应证\r\n[考点还原]（P875）\u201c表9-2-1  常见急性中毒诊治要点\u201d（P879）\u201c（3）洗胃\u20262）禁忌证：吞服强腐蚀性毒物\u201d（P875）\u201c表9-2-1  常见急性中毒诊治要点\u201d（P879）\u201c（3）洗胃\u20262）禁忌证：吞服强腐蚀性毒物\u201d（B错）。\r\n[解析]水杨酸类中毒应该洗胃，否则会经胃大量吸收而加重毒性。石炭酸、醋酸、硝酸和氯化高汞对胃黏膜均有腐蚀作用，插胃管洗胃有引起胃穿孔的危险，故不宜洗胃。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"437","all_num":"731","types":0,"pname":"内科学"},{"id":"484","name":"以下哪种物质可使下食管括约肌张力增高：","data":{"A":"盐酸","B":"内因子","C":"胃蛋白酶","D":"胃泌素","E":"钙通道拮抗剂"},"da_an":"D","typeid":"117","time":"2005-07-01 16:38:36","xiang_jie":"[答案]D\r\n[考点]使下食管括约肌张力增高的物质\r\n[考点还原]（七版生理学P172）\u201c食物入胃后可引起的胃泌素和胃动素等的释放，使LES（食管下括约肌）收缩\u201d（D对）。\r\n[解析]由胃G细胞分泌的胃泌素可使下食管括约肌张力增高，而钙通道拮抗剂可使其降低，盐酸、内因子和胃蛋白酶对其影响不大。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"443","all_num":"821","types":0,"pname":"内科学"},{"id":"487","name":"溃疡性结肠炎患者腹痛、腹泻明显时，应用M胆碱受体阻断药剂量过大，可能引起下列哪项并发症：","data":{"A":"机械性肠梗阻","B":"肠穿孔","C":"中毒性结肠扩张","D":"结肠大出血","E":"以上均不是"},"da_an":"C","typeid":"117","time":"2005-07-01 16:39:51","xiang_jie":"[答案]C\r\n[考点]溃疡性结肠炎的并发症\r\n[考点还原]（P387）\u201c（一）中毒性巨结肠\u2026常因低钾、钡剂灌肠、使用抗胆碱能药物或阿片类制剂而诱发\u201d（C对）。\r\n[解析]M胆碱受体阻断药能抑制迷走神经，松弛肠道平滑肌，因此剂量过大时会引起中毒性结肠扩张，可能会引起麻痹性肠梗阻，而不会引起机械性肠梗阻，也不会引起肠穿孔和结肠大出血。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"606","all_num":"762","types":0,"pname":"内科学"},{"id":"491","name":"原发性肝癌的发生与下列哪种因素最有关：","data":{"A":"肠道戊型肝炎病毒感染","B":"肠道寄生虫感染","C":"肠道细菌感染","D":"黄曲霉毒素污染","E":"酒精中毒"},"da_an":"D","typeid":"117","time":"2005-07-01 16:41:03","xiang_jie":"[答案]D\r\n[考点]原发性肝癌的病因\r\n[考点还原]（P429）\u201c【病因和发病机制】\u2026（二）食物及饮水\u2026长期进食霉变食物（粮食受到黄曲霉素污染）或含亚硝胺食物、食物缺乏微量元素及饮用藻类毒素污染的水等都与肝癌发生有密切关系\u201d（七版病理学P195）\u201c黄曲霉菌、青霉菌等可以引起实验性肝癌，尤其是黄曲霉素B\u2081与肝细胞肝癌的密切关系受到人们的高度重视\u201d（D对）。\r\n[解析]经动物实验和流行病学调查发现，黄曲霉素的代谢产物黄曲霉毒素B1有强烈的致肝癌作用，但尚未发现原发性肝癌与肠道戊型肝炎病毒感染、肠道寄生虫感染、肠道细菌感染、酒精中毒有相关性，而与乙型肝炎病毒感染可能有一定关系。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"628","all_num":"763","types":0,"pname":"内科学"},{"id":"496","name":"患者女性，28岁，右下腹痛、腹泻伴关节酸痛、低热半年，查体心肺正常，腹软，右下腹触及可疑肿块，X线钡餐检查显示回盲部有钡影跳跃征象（Stierlin\u2019s sign）,最可能的诊断是：","data":{"A":"Crohn病（克罗恩病）","B":"肠结核","C":"阿米巴痢疾","D":"右半结肠癌","E":"溃疡性结肠炎"},"da_an":"B","typeid":"117","time":"2018-09-13 16:04:46","xiang_jie":"[答案]B\r\n[考点]肠结核的诊断和鉴别诊断\r\n[考点还原]（P379）\u201c（一）腹痛  多位于右下腹或脐周\u2026（二）大便习惯改变  溃疡型肠结核常伴腹泻\u2026（三）腹部肿块  多位于右下腹 \u201d（P380）\u201c结核毒血症状多见于溃疡型肠结核，为长期不规则低热\u201d（P380）\u201c溃疡型肠结核，钡剂于病变肠段呈现激惹征象，排空很快，充盈不佳，而在病变的上、下肠段则钡剂充盈良好，称为X线钡剂激惹征\u201d（B对）。\r\n[解析]本例患者的特点是右下腹触及可疑肿块，X线钡餐检查显示回盲部有钡影跳跃征象（Stierlin\u2019s sign），结合病史最可能的诊断是肠结核，而Crohn病和右半结肠癌虽可在右下腹触及可疑肿块，但X线不支持，阿米巴痢疾和溃疡性结肠炎时的体征和X线不支持。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"532","all_num":"745","types":0,"pname":"内科学"},{"id":"501","name":"消化性溃疡的命名主要是由于：","data":{"A":"溃疡发生于消化道","B":"溃疡影响消化功能","C":"溃疡形成与消化道功能障碍有关","D":"溃疡形成与胃酸和胃蛋白酶消化作用有关","E":"溃疡形成与消化道激素排泌紊乱有关"},"da_an":"D","typeid":"117","time":"2005-07-01 16:44:32","xiang_jie":"[答案]D\r\n[考点]消化性溃疡的发病机制\r\n[考点还原]（七版内科学P387）\u201c消化性溃疡主要指发生在胃和十二指肠的慢性溃疡\u2026因溃疡形成与胃酸/胃蛋白酶的消化作用有关而得名\u201d（D对）。\r\n[解析]消化性溃疡的命名主要是由于溃疡的形成与胃酸和胃蛋白酶消化作用有关，而其他提法均不确切。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"608","all_num":"734","types":0,"pname":"内科学"},{"id":"505","name":"判断胃酸缺乏最可靠的指标是：","data":{"A":"呕吐物无酸","B":"空腹胃液pH为7","C":"BAO为0","D":"MAO为0","E":"空腹胃液中游离酸为0"},"da_an":"D","typeid":"117","time":"2005-07-01 16:45:39","xiang_jie":"[答案]D\r\n[考点]判断胃酸缺乏的指标\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]MAO（maximal acid output,最大胃酸分泌）是指给予刺激后连续收集1小时胃液所测泌酸值，若无酸，即MAO为0，是胃酸缺乏最可靠的指标；BAO（basic acid output,基础胃酸分泌）是指抽取空腹胃液后，再连续收集1小时胃液所测泌酸值，未加刺激剂，若为0，刺激后还可能会有酸分泌，因此不如MAO可靠；呕吐物无酸、空腹胃液pH为7（中性表示无酸）和空腹胃液中游离酸为0还不如BAO可靠。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"547","all_num":"731","types":0,"pname":"内科学"},{"id":"510","name":"误服下列哪种药物应禁忌洗胃：","data":{"A":"东莨菪碱","B":"水杨酸盐","C":"氢氧化钠","D":"盐酸麻黄碱","E":"亚硝酸盐类"},"da_an":"C","typeid":"117","time":"2005-07-01 16:46:41","xiang_jie":"[答案]C\r\n[考点]中毒洗胃的禁忌证\r\n[考点还原]（P879）\u201c（3）洗胃\u20262）禁忌证：吞服强腐蚀性毒物、食管静脉曲张、惊厥或昏迷患者，不宜进行洗胃\u201d（P875）\u201c表9-2-1  常见急性中毒诊治要点\u201d（C对）。\r\n[解析]氢氧化钠属于强碱，是强腐蚀性毒物，误服后若插胃管洗胃有可能引起胃穿孔，故应视为禁忌，其他几种药物均可洗胃。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"477","all_num":"626","types":0,"pname":"内科学"},{"id":"515","name":"患有幽门螺杆菌相关性胃炎的病人，给予哪种抗生素最为宜：","data":{"A":"四环素","B":"红霉素","C":"庆大霉素","D":"先锋霉素Ⅳ","E":"阿莫西林"},"da_an":"E","typeid":"117","time":"2005-07-01 16:47:52","xiang_jie":"[答案]E\r\n[考点]治疗幽门螺杆菌的抗生素\r\n[考点还原]（P366）\u201c1.Hp相关胃炎  单独应用表4-4-1所列药物，均不能有效根除Hp。这些抗生素在酸性环境下不能正常发挥其抗菌作用，需要联合PPI抑制胃酸后，才能使其发挥作用。常用的联合方案有：1种PPI+2种抗生素或1种铋剂+2种抗生素，疗程7～14天\u201d。（P366）\u201c表4-4-1  具有杀灭和抑制Hp作用的药物\u201d（E对）。\r\n[解析]实验室药敏试验和临床经验均表明，阿莫西林是治疗幽门螺杆菌相关胃炎的最佳抗生素，其余几种抗生素均不能与之相比拟。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"637","all_num":"713","types":0,"pname":"内科学"},{"id":"519","name":"在肠结核的治疗中，下列哪一项不正确：","data":{"A":"为使病人早日康复，防止耐药性的产生，目前多采用长程抗结核治疗","B":"一般用异烟肼与利福平二种杀菌药联合","C":"开始治疗1〜2周即有症状改善","D":"腹痛可用抗胆碱能药物","E":"伴完全肠梗阻者应手术治疗"},"da_an":"A","typeid":"117","time":"2005-07-01 16:49:25","xiang_jie":"[答案]A\r\n[考点]肠结核的治疗\r\n[考点还原]（P71）\u201c（1）每日用药方案：①强化期：异烟肼、利福平、吡嗪酰胺和乙胺丁醇，顿服，2个月。②巩固期：异烟肼、利福平，顿服，4个月。简写为：2HRZE/4HR\u201d（B对）。（P381）\u201c（二）对症治疗  腹痛可用抗胆碱能药物\u201d（D对）。（P381）\u201c（三）手术治疗  适应证①完全性肠梗阻或部分性肠梗阻内科治疗无效者\u201d（E对）。\r\n[解析]在肠结核的治疗中，过去一般进行长程标准治疗，疗程在1〜1.5年，目前认为，为使病人早日康复，防止耐药性的产生，多采用短程化疗，疗程为6〜9个月，因此长程化疗是过去的观点，是不正确的。其余几项治疗均是正确的。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"539","all_num":"759","types":0,"pname":"内科学"},{"id":"526","name":"关于原发性肝癌的转移，下列哪项提法不正确：","data":{"A":"肝内血行转移发生最早，也最常见","B":"容易侵犯门静脉分支形成癌栓","C":"肝外血行转移中，转移至肺的几达半数","D":"经淋巴转移至肝门淋巴结的最多","E":"种植转移常见"},"da_an":"E","typeid":"117","time":"2005-07-01 16:50:35","xiang_jie":"[答案]E\r\n[考点]原发性肝癌的转移方式\r\n[考点还原]（P430）\u201c1.肝内转移  易侵犯门静脉及分支并形成癌栓（B对），脱落后在肝内引起多发性转移灶\u201d。（P430）\u201c2.肝外转移  ①血行转移：最常见转移至肺（C对）\u2026②淋巴转移：常见肝门淋巴结转移（D对）\u2026③种植转移：少见（E错，为本题正确答案）\u201d。\r\n[解析]关于原发性肝癌的转移，种植转移少见，因此常见的提法不正确。其余关于原发性肝癌转移的提法均是正确的。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"570","all_num":"729","types":0,"pname":"内科学"},{"id":"529","name":"下列哪项不符合由胃泌素瘤引起的消化性溃疡：","data":{"A":"多发生在球后十二指肠降段和横段，或空肠近端","B":"常规胃手术后不易复发","C":"易并发出血、穿孔和梗阻","D":"基础胃酸分泌过度","E":"常伴腹泻"},"da_an":"B","typeid":"117","time":"2005-07-01 16:51:44","xiang_jie":"[答案]B\r\n[考点]消化性溃疡的鉴别诊断\r\n[考点还原]（P372）\u201c（三）Zollinger-Ellison综合征\u2026该综合征由促胃液素瘤或促胃液素细胞增生所致，临床以高胃酸分泌（D对），血促胃液素水平升高，多发、顽固及不典型部位消化性溃疡及腹泻为特征（E对）\u2026多数溃疡位于十二指肠球部和胃窦小弯侧，其余分布于食管下段、十二指肠球后及空肠等非典型部位（A错）\u201d。（七版内科学P391）\u201c胃泌素瘤与普通消化性溃疡的鉴别要点是该病溃疡发生于不典型部位，具难治性特点\u201d（B错，为本题正确答案）。\r\n[解析]由胃泌素瘤引起的消化性溃疡非常难治，常规胃手术后都见复发，因此胃手术后不易复发的提法不符合由胃泌素瘤引起的消化性溃疡，而其他几项均符合。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"611","all_num":"717","types":0,"pname":"内科学"},{"id":"533","name":"下列哪个不是有机磷中毒时的毒蕈碱样表现：","data":{"A":"恶心、呕吐和腹痛、腹泻","B":"多汗","C":"肌肉颤动","D":"瞳孔缩小","E":"心率减慢"},"da_an":"C","typeid":"117","time":"2005-07-01 16:52:45","xiang_jie":"[答案]C\r\n[考点]有机磷中毒的临床表现\r\n[考点还原]（P885）\u201c1.毒蕈碱样症状  又称M样症状。主要是副交感神经末梢过度兴奋，产生类似毒蕈碱样作用。平滑肌痉挛表现：瞳孔缩小（D对），胸闷、气短、呼吸困难，恶心、呕吐、腹痛、腹泻（A对）；括约肌松弛表现：大小便失禁；腺体分泌增加表现：大汗（B对）、流泪和流涎\u201d。（P885）\u201c2.烟碱样症状  又称N样症状。在横纹肌神经肌肉接头处ACh蓄积过多，出现肌纤维颤动（C错，为本题正确答案）\u201d。\r\n[解析]几个选项中肌肉颤动是有机磷中毒时的烟碱样表现，而其余几项均属于毒蕈碱样表现。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"521","all_num":"652","types":0,"pname":"内科学"},{"id":"539","name":"下列哪项是以结合胆红素增高为主的黄疸：","data":{"A":"溶血性黄疸","B":"肝炎后高胆红素血症","C":"Gilbert综合征","D":"Crigber-Najjar综合征","E":"Dubin-Johnson综合征"},"da_an":"E","typeid":"117","time":"2005-07-01 16:53:54","xiang_jie":"[答案]E\r\n[考点]黄疸的鉴别诊断\r\n[考点还原]（八版诊断学P38）\u201c1.溶血性黄疸  实验室检查血清UCB增加为主，CB基本正常\u201d（A错）。（八版诊断学P38）\u201c2.肝细胞性黄疸  实验室检查血清中CB与UCB均增加，黄疸型肝炎时，CB增加幅度多高于UCB\u201d（B错）。（八版诊断学P38）\u201cGlbert综合征（C错）：系由肝细胞摄取UCB功能障碍及微粒体内葡萄糖醛酸转移酶不足，致血中UCB增高而出现黄疸\u201d。（八版诊断学P38）\u201cDubin-Johnson综合征（E对）：系由肝细胞对CB及某些阴离子向毛细胆管排泄发生障碍，致血清CB增加而发生的黄疸\u201d。 （八版诊断学P38-P39）\u201cCrigler-najjar综合征（D错）：系由肝细胞缺乏葡萄糖醛酸转移酶，致UCB不能形成CB，导致血中UCB增多而出现黄疸\u201d。\r\n[解析]Dubin-Johnson综合征是肝细胞对结合胆红素、BSP、靛青绿等有遗传性分泌排泄功能缺陷的疾病，因而会发生高结合胆红素血症。而溶血性黄疸、肝炎后高胆红素血症、Gilbert综合征和Crigber-Najjar综合征则分别由于非结合胆红素来源过多、摄取障碍和因葡萄糖醛酸转移酶活力减低或缺如使非结合胆红素转变为结合胆红素发生障碍所致，所以都是以非结合胆红素增高为主的黄疸。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"302","all_num":"721","types":0,"pname":"内科学"},{"id":"544","name":"现在认为下列哪项最不可能引起溃疡性结肠炎：","data":{"A":"结肠的感染","B":"变态反应","C":"细胞免疫异常","D":"遗传","E":"过敏反应"},"da_an":"A","typeid":"117","time":"2005-07-01 16:54:56","xiang_jie":"[答案]A\r\n[考点]溃疡性结肠炎的病因\r\n[考点还原]（P385）\u201c【病因和发病机制】 由环境、遗传（D错）、感染（A错）和免疫（BCE错）多因素相互作用所致\u201d。\r\n[解析]溃疡性结肠炎的病因尚未完全明确，目前一般认为其发病主要是由于免疫机制异常，并与遗传因素有关，而感染在本病发病中的地位尚难肯定，因此结肠感染最不可能引起溃疡性结肠炎。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"532","all_num":"753","types":0,"pname":"内科学"},{"id":"3566","name":"肝硬化腹水患者，应首选的利尿剂为：","data":{"A":"甘露醇","B":"利尿酸钠（依他尼酸)","C":"双氢氯噻嗪（氢氯噻嗪)","D":"安体舒通（螺内酯）","E":"速尿（呋塞米）"},"da_an":"D","typeid":"117","time":"2018-11-17 17:31:40","xiang_jie":"[答案]D\r\n[考点]肝硬化腹水的治疗\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]肝硬化腹水的形成原因之一是继发性醛固酮增多，而安体舒通（螺内酯）有抗醛固酮作用，临床实践证明安体舒通对肝硬化腹水病人有明显利尿效果，因此首选。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"660","all_num":"712","types":0,"pname":"内科学"},{"id":"3567","name":"患者男，50岁，既往体健，查体时发现肝在右季肋下2cm，质硬、无压痛，脾可触及，ALT正常范围，肝穿刺病理有假小叶形成，应诊断为：","data":{"A":"慢性活动性肝炎","B":"慢性持续性肝炎","C":"代偿期肝硬化","D":"肝淤血","E":"多囊肝"},"da_an":"C","typeid":"117","time":"2018-08-05 21:08:00","xiang_jie":"[答案]C\r\n[考点]肝硬化的诊断\r\n[考点还原]（P420）\u201c【发病机制及病理】\u2026汇管区和肝包膜的纤维束向肝小叶中央静脉延伸扩展，这些纤维间隔包绕再生结节或将残留肝小叶重新分割，改建成为假小叶，形成典型的肝硬化组织病理形态\u201d。（P421）\u201c（一）代偿期  大部分患者无症状或症状较轻，可有腹部不适、乏力、食欲减退、消化不良和腹泻等症状\u2026患者营养状态尚可，肝脏是否肿大取决于不同类型的肝硬化，脾脏因门静脉高压常有轻、中度肿大。肝功能实验检查正常或轻度异常\u201d（C对）。\r\n[解析]此病人肝脾肿大，但ALT在正常范围，因而不是慢性活动性或持续性肝炎，病理有假小叶形成，因而不符合肝淤血和多囊肝，应诊断为代偿期肝硬化。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"643","all_num":"691","types":0,"pname":"内科学"},{"id":"3569","name":"胆汁郁积性黄疸时，下列哪项正确：","data":{"A":"血清总胆固醇降低 ","B":"血清结合胆红素降低","C":"血清碱性磷酸酶降低","D":"血清γ-谷氨酰转肽酶降低","E":"尿胆原降低"},"da_an":"E","typeid":"117","time":"2018-09-13 14:18:38","xiang_jie":"[答案]E\r\n[考点]胆汁郁积性黄疸的实验室检查特点\r\n[考点还原]（八版诊断学P38）\u201c实验室检查血清CB增加为主（B错）\u2026因肠肝循环途径被阻断，故尿胆原（E对）及粪胆原减少或缺如。血清碱性磷酸酶（C错）及总胆固醇（A错）升高\u201d。（P366）\u201c因此当肝内合成亢进或胆汁排出受阻时，血清中GGT（γ-谷氨酞转肽酶）（B错）增高\u201d。\r\n[解析]胆汁郁积性黄疸时，由于胆红素的\u201c肠肝循环\u201d受阻，应该使尿胆原降低，因而答案是E，其余四项均应升高，因此降低是不正确的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"409","all_num":"699","types":0,"pname":"内科学"},{"id":"3572","name":"下列哪一项不符合重度溃疡性结肠炎：","data":{"A":"腹泻每日6次以上","B":"体温达38℃以上","C":"脉搏在90次/分以上","D":"红细胞沉降率大于30mm/第1小时","E":"血红蛋白在100g/L以下"},"da_an":"B","typeid":"117","time":"2018-08-05 21:10:08","xiang_jie":"[答案]B\r\n[考点]重度溃疡性结肠炎的临床特点\r\n[考点还原]（P386-P387）\u201c2.临床严重程度\u2026重度：腹泻＞6次/日（A对），有明显黏液脓血便，体温＞37.5℃（B错，为本题正确答案）、脉搏＞90次/分（C对），血红蛋白＜100g/L（E对），血沉＞30mm/h（D对）\u201d。\r\n[解析]这是道记忆题，重度溃疡性结肠炎体温应该是达37.5℃以上，因而B不符合，其余各项均符合。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"412","all_num":"727","types":0,"pname":"内科学"},{"id":"3573","name":"下列哪种肝硬化引起肝性脑病最多见：","data":{"A":"酒精性肝硬化","B":"原发性胆汁性肝硬化","C":"淤血性肝硬化","D":"肝炎后肝硬化","E":"血吸虫病性肝硬化"},"da_an":"D","typeid":"117","time":"2018-09-13 14:20:00","xiang_jie":"[答案]D\r\n[考点]肝性脑病的病因\r\n[考点还原]（P419）\u201c【病因】 在我国，目前引起肝硬化的病因以病毒性肝炎为主\u201d（P434）\u201c【病因与发病机制】 大部分肝性脑病由肝硬化引起\u201d（D对）。\r\n[解析]肝炎后肝硬化是由乙型、丙型或乙型加丁型肝炎重叠感染，通常经过慢性肝炎，尤其是慢性活动性肝炎阶段演变而来，在我国肝硬化中占首位，引起肝性脑病亦最常见，因而答案是D。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"566","all_num":"678","types":0,"pname":"内科学"},{"id":"3575","name":"克罗恩（Crohn）病最常见的并发症是：","data":{"A":"腹腔内脓肿","B":"吸收不良综合征","C":"肠梗阻","D":"大量便血","E":"发生癌变"},"da_an":"C","typeid":"117","time":"2018-09-13 14:21:02","xiang_jie":"[答案]C\r\n[考点]克罗恩病的并发症\r\n[考点还原]（P391）\u201c【并发症】 肠梗阻最常见（C对），其次是腹腔内脓肿（A错），偶可并发急性穿孔或大量便血（D错）。直肠或结肠黏膜受累者可发生癌变（E错）\u201d。\r\n[解析]所列举五种并发症在克罗恩病时均可发生，但最常见的是肠梗阻。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"649","all_num":"686","types":0,"pname":"内科学"},{"id":"3577","name":"关于A型胃炎，下列哪项是正确的：","data":{"A":"较常见","B":"大多数由幽门螺杆菌感染引起","C":"病变主要累及胃体和胃底","D":"发病与遗传素质无关","E":"最终不易导致恶性贫血\t"},"da_an":"C","typeid":"117","time":"2018-11-11 11:50:55","xiang_jie":"[答案]C\r\n[考点]A型胃炎的特点\r\n[考点还原]（八版病理学P189）\u201c表9-1  慢性萎缩性胃炎A、B型比较表\u201d（C对ABDE错）。\r\n[解析]A型胃炎又称慢性胃体炎，病变主要累及胃体和胃底，该病不常见，主要由自身免疫反应引起，最终可导致恶性贫血，常有遗传因素参与发病，因而答案是C。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"630","all_num":"694","types":0,"pname":"内科学"},{"id":"3578","name":"关于消化性溃疡的癌变下列哪项是正确的","data":{"A":"各种消化性溃疡均有癌变可能","B":"癌变发生于溃疡边缘","C":"癌变率可达1%以上","D":"症状经严格的4周内科治疗无改善","E":"癌变率与年龄无关"},"da_an":"B","typeid":"117","time":"2018-09-13 14:22:33","xiang_jie":"[答案]B\r\n[考点]消化性溃疡的癌变\r\n[考点还原]（P371）\u201c（四）癌变  溃疡由良性演变为恶性的几率很低，估计＜1％胃溃疡有可能癌变，十二指肠球部溃疡一般不发生癌变\u201d（AC错）。（七版内科学P392）\u201cGU癌变发生于溃疡边缘（B对），据报道癌变率在1％左右。长期慢性GU病史、年龄在45岁以上（E错）、溃疡顽固不愈者应提高警惕\u201d。（七版内科学P400）\u201c胃溃疡经正规治疗2个月无效，X线钡餐提示溃疡增大者\u201d（D错）。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"498","all_num":"695","types":0,"pname":"内科学"},{"id":"3581","name":"肝硬化失代偿期病人的下列检查中，哪项不正确：","data":{"A":"凝血因子减少","B":"血红蛋白减低","C":"雄激素减少","D":"雌激素减少","E":"肾上腺糖皮质激素可减少"},"da_an":"D","typeid":"117","time":"2018-09-13 14:23:57","xiang_jie":"[答案]D\r\n[考点]肝硬化失代偿期临床表现\r\n[考点还原]（P421）\u201c1.肝功能减退\u2026（4）出血和贫血（B对）：常有鼻腔、牙龈出血及皮肤黏膜瘀点、瘀斑和消化道出血等，与肝合成凝血因子减少（A对）、脾功能亢进和毛细血管脆性增加有关\u201d。（P421）\u201c1.肝功能减退\u2026（5）内分泌失调  ①性激素代谢：常见雌激素增多（D错，为本题正确答案），雄激素减少（C对）\u2026②肾上腺皮质功能：肝硬化时，合成肾上腺皮质激素重要的原料胆固醇酯减少，肾上腺皮质激素合成不足（E对）\u201d。\r\n[解析]肝硬化失代偿期病人，雌激素应该是增高而不是减少，而凝血因子、雄激素和肾上腺皮质激素均可减少，血红蛋白减低，因而答案是D。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"633","all_num":"719","types":0,"pname":"内科学"},{"id":"3583","name":"对幽门螺杆菌感染阳性的消化性溃疡治疗策略中，下列哪项不正确：","data":{"A":"给制酸剂同时加抗菌治疗","B":"给黏膜防护剂同时加抗菌治疗","C":"制酸剂可用H2受体拮抗剂或质子泵阻滞剂","D":"制酸剂应用疗程在DU应适当较GU时延长","E":"抗生素首选一种，以二周为一疗程"},"da_an":"D","typeid":"117","time":"2018-11-21 11:50:43","xiang_jie":"[答案]D\r\n[考点]幽门螺杆菌阳性的消化性溃疡治疗\r\n[考点还原]（七版内科学P393）\u201c研究证明以PPI（A对）或胶体铋（B对）为基础加上两种抗生素（E错）的三联治疗方案有较高根除率\u201d。\r\n[答案]D\r\n[解析]对幽门螺杆菌感染阳性的消化性溃疡治疗策略中，制酸剂在DU疗程为4〜6周，而GU因溃疡愈合较慢，疗程应适当延长至8〜12周，DE均错误，原答案为D.\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"519","all_num":"756","types":0,"pname":"内科学"},{"id":"3586","name":"Cushing ulcer是指由下列哪种原因引起者：","data":{"A":"严重的脏器疾病","B":"大手术","C":"大面积烧伤","D":"休克","E":"中枢神经病变\t"},"da_an":"E","typeid":"117","time":"2018-09-13 14:26:49","xiang_jie":"[答案]E\r\n[考点]急性胃炎的病因\r\n[考点还原]（P472）\u201c（三）应激性溃疡或急性糜烂性溃疡  约占20％。近年来，其发生率有明显上升。多与休克、复合性创伤、严重感染、严重烧伤（Curling溃疡）（D错）、严重脑外伤（Cushing溃疡）或大手术有关\u201d。\r\n[解析]这是一道记忆题，Cushing ulcer是指中枢神经病变引起者。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"500","all_num":"747","types":0,"pname":"内科学"},{"id":"3589","name":"下列哪一项属于胃十二指肠黏膜防卫因子：","data":{"A":"胃酸/胃蛋白酶","B":"前列腺素","C":"胆盐","D":"胰酶","E":"药物（NSAID"},"da_an":"B","typeid":"117","time":"2018-09-13 14:28:16","xiang_jie":"[答案]B\r\n[考点]消化性溃疡的病因和发病机制\r\n[考点还原]（P369）\u201c消化性溃疡发病的机制是胃酸、胃蛋白酶的侵袭作用与黏膜的防御能力间失去平衡\u201d（A错）。（P369）\u201cNSAIDs是导致胃黏膜损伤最常用的药物\u201d（E错）。（P369）\u201c十二指肠-胃反流可导致胃黏膜损伤\u201d（CD错）。（七版内科学P393）\u201c米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用，主要用于NSAID溃疡的预防\u201d（B对）。\r\n[解析]这是一道记忆题，前列腺素属于胃十二指肠黏膜防卫因子。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"590","all_num":"728","types":0,"pname":"内科学"},{"id":"3590","name":"结核性腹膜炎的抗结核治疗，下列哪项不正确：","data":{"A":"其疗效一般比溃疡型肠结核略好","B":"粘连型合并渗出者，病变不易控制","C":"一般用3〜4种药物联合强化治疗","D":"继发于体内其他结核病的病人，临床多选用以往未用或少用药物","E":"有血行播散或严重结核毒性症状者，可短期加用肾上腺糖皮质激素"},"da_an":"A","typeid":"117","time":"2018-09-13 14:29:05","xiang_jie":"[答案]A\r\n[考点]结核性腹膜炎的抗结核治疗\r\n[考点还原]（P73）\u201c（二）糖皮质激素  糖皮质激素治疗结核病的应用主要是利用其抗炎、消毒作用，仅用于结核毒性症状严重者\u201d（E对）。\r\n[解析]结核性腹膜炎的抗结核治疗，其疗效一般比溃疡型肠结核略差，而不是略好，因而不正确，而其他四项均是正确的，因而答案是A。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"505","all_num":"727","types":0,"pname":"内科学"},{"id":"3593","name":"肝硬化病人引起肝肾综合征的因素中，下列哪项不正确：","data":{"A":"去甲肾上腺素分泌增加","B":"肾素-血管紧张素Ⅱ系统活性增强","C":"肾前列腺素合成增加","D":"血栓素A2增加","E":"白三烯产生增加"},"da_an":"C","typeid":"117","time":"2018-09-13 14:30:51","xiang_jie":"[答案]C\r\n[考点]肝硬化时肝肾综合征发生机制\r\n[考点还原] （十四版实用内科学P2001）\u201c5.泌尿系统  肝硬化患者肝窦压升高，NO增加，造成内脏动脉扩张，有效血容量不足，反射性激活肾素-血管紧张素（B对）和交感系统（A对）产生肾动脉极度收缩，造成肾内血供过度不足，产生肝肾综合征\u201d。\r\n[解析]肝硬化病人引起肝肾综合征的因素很多，这些因素使肾血管收缩，引起肾皮质血流量和肾小球滤过率持续降低，题中列举的因素除C外均是正确的，因为前列腺素是使血管扩张，所以病人的肾前列腺素合成是减少而不是增加，故答案是C。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"497","all_num":"686","types":0,"pname":"内科学"},{"id":"3595","name":"肝硬化病人肝肾综合征的特点是：","data":{"A":"血BUN↑ 血钠↑ 尿钠↑","B":"血BUN↑ 血钠↑ 尿钠↓","C":"血BUN↑ 血钠↓ 尿钠↓","D":"血BUN↓ 血钠↓ 尿钠↓","E":"血BUN↑ 血钠↓ 尿钠↑"},"da_an":"C","typeid":"117","time":"2018-09-13 14:31:39","xiang_jie":"[答案]C\r\n[考点]肝硬化时肝肾综合征的特点\r\n[考点还原]（七版内科学P450）\u201c（六）肝肾综合征\u2026HRS临床表现为自发性少尿或无尿，氮质血症和血肌酐升高，稀释性低钠血症，低尿钠\u201d（C对）。\r\n[解析]肝肾综合征是由于肝硬化病人少尿或无尿而引起的氮质血症、稀释性低钠血症和低尿钠，因此血BUN↑、血钠↓、尿钠↓是正确的，而其余各项均不正确。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"614","all_num":"673","types":0,"pname":"内科学"},{"id":"3597","name":"Curling ulcer是指下列哪项原因引起者：","data":{"A":"大手术","B":"休克","C":"大面积烧伤","D":"颅内病变","E":"严重的脏器疾病"},"da_an":"C","typeid":"117","time":"2018-09-13 14:32:40","xiang_jie":"[答案]C\r\n[考点]急性胃炎的病因\r\n[考点还原]（P472）\u201c（三）应激性溃疡或急性糜烂性溃疡  约占20％。近年来，其发生率有明显上升。多与休克、复合性创伤、严重感染、严重烧伤（Curling溃疡）（C对）、严重脑外伤（Cushing溃疡）（D错）或大手术有关\u201d。\r\n[解析]Curling ulcer是指大面积烧伤引起的应激性溃疡，而其余各项均不是。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"551","all_num":"657","types":0,"pname":"内科学"},{"id":"3600","name":"有关肝癌的临床表现，下列哪项不正确：","data":{"A":"可完全不痛或仅有轻微钝痛","B":"不会出现急腹症表现","C":"有时表现为膈抬高","D":"位于肋弓下的癌结节最易被触到","E":"有时可在腹壁上听到吹风样血管杂音"},"da_an":"B","typeid":"117","time":"2018-09-13 14:33:34","xiang_jie":"[答案]B\r\n[考点]肝癌的临床表现\r\n[考点还原]（P430）\u201c（一）肝区疼痛\u2026如癌肿生长缓慢，则可完全无痛或仅有轻微钝痛（A对）。当肝表面的癌结节破裂，可突然引起剧烈腹痛，从肝区开始迅速延至全腹，产生急腹症的表现（B错，为本题正确答案），如出血量大时可导致休克\u201d。（P430）\u201c（二）肝大\u2026肝癌突出于右肋弓下或剑突下时，上腹可呈现局部隆起或饱满（D对）；如癌肿位于膈面，则主要表现为膈肌抬高（C对）而肝下缘不下移\u201d。\r\n[解析]当肝表面的癌结节破裂，使坏死的癌组织及血液进入腹腔时，可产生急腹症表现，因而\u201c不会出现急腹症表现\u201d不正确。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"512","all_num":"643","types":0,"pname":"内科学"},{"id":"3602","name":"肝性脑病的脑性毒物中，下列哪项不正确","data":{"A":"氨","B":"芳香族氨基酸","C":"γ-氨基丁酸","D":"蛋氨酸的代谢产物\u2014\u2014硫醇","E":"中链脂肪酸"},"da_an":"E","typeid":"117","time":"2018-09-13 14:34:36","xiang_jie":"[答案]E\r\n[考点]肝性脑病的发病机制\r\n[考点还原]（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（A对）\u2026（二）神经递质的变化  1.γ-氨基丁酸/苯二氮䓬（GABA/BZ）神经递质（C对）\u2026复合体中任何一个受体被激活均可促使氯离子内流而使神经传导被抑制\u20262.假性神经递质\u2026食物中的芳香族氨基酸（B对）如酪氨酸、苯丙氨酸等经肠菌脱羧酶的作用分别转变为酪胺和苯乙胺\u2026在脑内经β羟化酶的作用分别形成β羟酪胺和苯乙醇胺\u2026称为假性神经递质。当假性神经递质被脑细胞摄取并取代了突触中的正常递质，则神经传导发生障碍\u201d。\r\n[解析]氨、芳香族氨基酸、γ-氨基丁酸、蛋氨酸的代谢产物\u2014\u2014硫醇均为肝性脑病的脑性毒物，而中链脂肪酸则不是，应该是短链脂肪酸。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"443","all_num":"611","types":0,"pname":"内科学"},{"id":"3604","name":"急性坏死性胰腺炎时，下列哪项检查结果正确：","data":{"A":"血清淀粉酶均升高","B":"血清脂肪酶早期升高","C":"血糖升高","D":"血钙升高","E":"血白蛋白升高"},"da_an":"C","typeid":"117","time":"2018-09-13 14:36:02","xiang_jie":"[答案]C\r\n[考点]急性坏死性胰腺炎的实验室检查\r\n[考点还原]（P441）\u201c2.脂肪酶  血清脂肪酶于起病后24～72小时开始升高（B错）\u201d。（P441）\u201c血清淀粉酶、脂肪酶的高低与病情程度无确切关联，部分患者的两种胰酶可不升高（AB错）\u201d。（P441）\u201c表4-18-2  反映SAP病理生理变化的实验室检测指标\u201d（C对DE错）。\r\n[解析]急性坏死性胰腺炎时，血糖是升高，而血清淀粉酶可升高，但也可低于正常，血清脂肪酶早期不升高，血钙是降低，血白蛋白不会升高，而是正铁血由蛋白升高。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"452","all_num":"632","types":0,"pname":"内科学"},{"id":"3606","name":"下列导致十二指肠溃疡胃酸分泌异常的因素中哪项不正确：","data":{"A":"壁细胞对胃泌素特别敏感","B":"胃酸反馈性抑制机制失灵","C":"对进餐刺激后的胃酸分泌在溃疡活动期增强","D":"晚间胃酸分泌明显增多","E":"胃排空减慢"},"da_an":"E","typeid":"117","time":"2018-09-13 14:37:16","xiang_jie":"[答案]E\r\n[考点]消化性溃疡的发病机制\r\n[考点还原]（七版内科学P389）\u201c研究发现部分DU患者胃排空增快，这可使十二指肠球部酸负荷增大\u201d（E错，为本题正确答案）。（十四版实用内科学P1915）\u201c胃酸分泌增多的因素包括：1.壁细胞数量增多；2.壁细胞对刺激物质的敏感性增强（AC对）；3.胃酸分泌正常反馈抑制机制缺陷（B对）；4.迷走神经张力增高（D对）\u201d。\r\n[解析]十二指肠溃疡病人有胃排空加速现象，这可提高十二指肠的酸负荷，因而\u201c胃排空减慢\u201d不正确，其余各项均正确。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"435","all_num":"629","types":0,"pname":"内科学"},{"id":"3609","name":"下列哪一项不是肝硬化代偿期的表现：","data":{"A":"乏力、食欲减退","B":"食管和胃底静脉曲张","C":"肝脏质地结实或偏硬","D":"脾脏中度肿大","E":"肝功能轻度异常"},"da_an":"B","typeid":"117","time":"2018-09-13 14:38:16","xiang_jie":"[答案]B\r\n[考点]肝硬化的临床表现\r\n[考点还原]（P421）\u201c（一）代偿期  大部分患者无症状或症状较轻，可有腹部不适、乏力、食欲减退（A对）、消化不良和腹泻等症状\u2026脾脏因门静脉高压常有轻、中度肿大（D对）。肝功能实验室检查正常或轻度异常（E对）\u201d。（P421）\u201c失代偿期  症状较明显，主要有肝功能减退和门静脉高压两类临床表现\u20262.门静脉高压 多属肝内型，门静脉高压常导致食管胃底静脉曲张\u201d（B错，为本题正确答案）。（七版内科学P448）\u201c代偿期肝硬化  症状轻且无特异性。可有乏力、食欲减退、腹胀不适等。患者营养状况一般，可触及肿大的肝脏、质偏硬（C对），脾可肿大。肝功能检查正常或仅有轻度酶学异常\u201d。\r\n[解析]肝硬化的临床表现包括代偿期和失代偿期的表现，代偿期的表现缺乏特异性，而失代偿期表现包括肝功能减退的临床表现和门静脉高压症，食管和胃底静脉曲张是门静脉高压症的三大表现之一，故答案是B。\r\n636.[答案]B\r\n[考点]肝硬化的临床表现\r\n[解析]肝硬化的临床表现包括代偿期和失代偿期的表现，代偿期的表现缺乏特异性，而失代偿期表现包括肝功能减退的临床表现和门静脉高压症，食管和胃底静脉曲张是门静脉高压症的三大表现之一，故答案是B。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"515","all_num":"605","types":0,"pname":"内科学"},{"id":"3611","name":"下列哪一种并发症在溃疡性结肠炎最少见：","data":{"A":"中毒性结肠扩张","B":"直肠结肠癌变","C":"直肠结肠大量出血","D":"肠梗阻","E":"瘘管形成"},"da_an":"E","typeid":"117","time":"2018-11-11 10:48:56","xiang_jie":"[答案]E\r\n[考点]溃疡性结肠炎的并发症\r\n[考点还原]（P386）\u201c由于结肠病变一般限于黏膜与黏膜下层，很少深入肌层，所以并发结肠穿孔、瘘管（E对）或周围脓肿少见\u201d。\r\n[解析]题中所列五项均为溃疡性结肠炎的并发症，以中毒性结肠扩张最常见，而瘘管形成最少见。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"435","all_num":"641","types":0,"pname":"内科学"},{"id":"3613","name":"下列哪一种药物常作为根除幽门螺杆菌的基础药物：","data":{"A":"甲氰咪呱","B":"雷尼替丁","C":"奥美拉唑","D":"碳酸钙","E":"胶体铝镁合剂"},"da_an":"C","typeid":"117","time":"2018-09-13 14:40:19","xiang_jie":"[答案]C\r\n[考点]溃疡病的幽门螺杆菌治疗\r\n[考点还原]（七版内科学P393）\u201cPPI及胶体铋体也能抑制幽门螺旋杆菌\u201d（C对）。\r\n[解析]溃疡病的幽门螺杆菌治疗常以质子泵抑制剂（PPI）或胶体铋剂为基础药物，加两种抗菌药物治疗。奥美拉唑是PPI中常用的一种，因此答案是C，其余均不是。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"571","all_num":"589","types":0,"pname":"内科学"},{"id":"3615","name":"关于十二指肠溃疡（DU）的描述，下列哪项不正确：","data":{"A":"DU患者中，2/3有胃酸分泌过高现象","B":"壁细胞总数小于10亿个不会发生DU","C":"MAO小于10mmol/h不会发生DU","D":"由幽门螺杆菌引起的DU均有胃窦炎存在","E":"DU有导致胃酸分泌异常的多种因素"},"da_an":"A","typeid":"117","time":"2018-09-13 14:41:52","xiang_jie":"[答案]A\r\n[考点]十二指肠溃疡的发病机制\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]十二指肠溃疡的发病与胃酸密切相关，但有胃酸分泌过高现象者仅约1/3，所以该题答案是A，而其余各项均可见于十二指肠溃疡。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"262","all_num":"605","types":0,"pname":"内科学"},{"id":"3617","name":"B型胃炎主要是由下列哪个原因引起：","data":{"A":"幽门螺杆菌感染","B":"胆汁反流","C":"消炎药物","D":"吸烟","E":"酒癖"},"da_an":"A","typeid":"117","time":"2018-09-13 14:43:21","xiang_jie":"[答案]A\r\n[考点]B型胃炎的病因\r\n[考点还原]（八版病理学P189）\u201c表9-1  慢性萎缩性胃炎A、B型比较表\u201d（A对）。\r\n[解析]B型胃炎又称慢性胃窦炎，已明确绝大多数（90%）是由幽门螺杆菌感染引起，仅少数由于其余原因包括胆汁反流、消炎药物（非甾体抗炎药）、吸烟和酒癖等所致，所以答案是A。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"565","all_num":"569","types":0,"pname":"内科学"},{"id":"3619","name":"出血坏死型胰腺炎时的Cullen征是指：","data":{"A":"胁腹皮肤呈灰紫色斑","B":"脐周皮肤呈灰紫色斑","C":"胁腹皮肤青紫","D":"脐周皮肤青紫","E":"脐周皮肤红斑"},"da_an":"D","typeid":"117","time":"2018-09-13 14:46:35","xiang_jie":"[答案]D\r\n[考点]出血坏死型胰腺炎的临床表现\r\n[考点还原]（七版内科学P471）\u201c少数患者因胰酶、坏死组织及出血沿腹膜间隙与肌层渗入腹壁下，致两侧胁腹部皮肤呈暗灰蓝色，称Grey-Turner征；可致脐周围皮肤青紫，称Cullen征（D对）\u201d。\r\n[解析]出血坏死型胰腺炎时因胰酶、坏死组织及出血沿腹膜间隙与肌层渗入腹壁下，致脐周围皮肤青紫，称Cullen征，故答案是D。而胁腹皮肤青紫称Grey-Furner征，其余三项亦不正确。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"386","all_num":"589","types":0,"pname":"内科学"},{"id":"3622","name":"下列H2RA药物中，抑酸作用最强且持久而副作用少的是：","data":{"A":"西咪替丁","B":"雷尼替丁","C":"法莫替丁","D":"尼扎替丁","E":"罗沙替丁"},"da_an":"C","typeid":"117","time":"2018-09-13 14:47:26","xiang_jie":"[答案]C\r\n[考点]消化性溃疡的抑酸药物治疗\r\n[考点还原]（八版药理学P304）\u201c表32-1\u201d（C对）。\r\n[解析]题中所列五种药物均为H2受体拮抗剂（H2RA），其中以法莫替丁的抑酸作用最强而持久，口服20mg对胃酸分泌的抑制作用能维持12小时以上，而且无明显副作用。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"496","all_num":"579","types":0,"pname":"内科学"},{"id":"3624","name":"关于肝性脑病的氨中毒学说下列正确的是：","data":{"A":"NH4＋有毒性，能透过血脑屏障","B":"肠内pH＞6时，NH3不易被吸收","C":"低钾碱中毒时增加氨毒性","D":"腹泻时增加氨毒性","E":"高血糖时增加氨毒性"},"da_an":"C","typeid":"117","time":"2018-09-13 14:48:52","xiang_jie":"[答案]C\r\n[考点]肝性脑病的氨中毒学说\r\n[考点还原]（P434）\u201c（一）氨中毒\u2026氨以非离子型氨（NH\u2083）和离子型氨（NH\u2084\u207a）两种形式存在，氨在肠道的吸收主要以NH\u2083弥散入肠黏膜，当结肠内pH＞6时，NH\u2084\u207a转为NH\u2083，大量弥散入血（C对B错）；pH＜6时，则NH\u2083从血液转至肠腔，随粪排泄\u2026游离的NH\u2083有毒性，且能透过血脑屏障（A错）\u201d。\r\n[解析]低钾碱中毒时，可促使NH3透过血脑屏障，进入脑细胞产生毒害，故低钾碱中毒时增加氨毒性，而其余各项均不正确。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"439","all_num":"576","types":0,"pname":"内科学"},{"id":"3626","name":"结核性腹膜炎病人的发热特点错误的是：","data":{"A":"一半有弛张热","B":"少数可呈稽留热","C":"高热伴明显毒血症者见于渗出型","D":"高热伴明显毒血症者见于干酪型","E":"高热伴明显毒血症者见于伴有粟粒型结核者"},"da_an":"A","typeid":"117","time":"2018-09-13 14:49:49","xiang_jie":"[答案]A\r\n[考点]结核性腹膜炎病人的发热特点\r\n[考点还原]（七版内科学P406）\u201c结核毒血症常见，主要是发热与盗汗。热型以低热与中等热为最多，约1/3患者有弛张热（A错，为本题正确答案），少数可呈稽留热（B对）。高热伴有明显毒血症主要见于渗出型（C对）、干酪型（D对），或见于伴有粟粒型肺结核（E对）、干酪样肺炎等严重结核病的患者\u201d。\r\n[解析]结核性腹膜炎病人以低热和中等热为最多，只有约1/3病人呈弛张热，不会达到一半，因而答案是A，其余均是正确的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"463","all_num":"578","types":0,"pname":"内科学"},{"id":"3628","name":"对于肠易激综合征病人，下列有关腹痛的描述，错误的是：","data":{"A":"部位不定","B":"以下腹和右下腹多见","C":"极少睡眠中痛醒","D":"多于排便或排气后缓解","E":"无明显体征"},"da_an":"B","typeid":"117","time":"2018-08-05 21:30:54","xiang_jie":"[答案]B\r\n[考点]肠易激综合征病人的腹痛特点\r\n[考点还原]（P400）\u201c【临床表现】\u2026几乎所有IBS患者都有不同程度的腹痛或腹部不适，部位不定（A对），以下腹和左下腹多见（B错，为本题正确答案），排便或排气后缓解（D对）。极少有睡眠中痛醒者（C对）\u201d。（P400）\u201c【临床表现】\u2026一般无明显体征\u201d（E对）。\r\n[解析]几乎所有肠易激综合征病人都有不同程度的腹痛，以下腹和左下腹多见，而不是右下腹，其余有关腹痛的描述均是正确的。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"428","all_num":"587","types":0,"pname":"内科学"},{"id":"3630","name":"下列有关胃食管反流病烧心的描述错误的是：","data":{"A":"烧心是指胸骨后或剑突下烧灼感","B":"常在餐后半小时出现","C":"腹压增高时可加重","D":"弯腰时可加重","E":"卧位可加重"},"da_an":"B","typeid":"117","time":"2018-09-13 14:51:44","xiang_jie":"[答案]B\r\n[考点]胃食管反流病的临床表现\r\n[考点还原]（P357）\u201c烧心是指胸骨后或剑突下烧灼感（A对），常由胸骨下段向上延伸。烧心和反流常在餐后1小时出现（B错，为本题正确答案），卧位（E对）、弯腰（D对）或腹压增高（C对）时可加重\u201d。\r\n[解析]烧心是胃食管反流病的最常见症状，常在餐后1小时出现，而不是半小时出现，其余均是正确的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"483","all_num":"563","types":0,"pname":"内科学"},{"id":"3634","name":"治疗重症胃食管反流病的首选药物是：","data":{"A":"雷尼替丁","B":"西沙必利","C":"奥美拉唑","D":"氢氧化铝","E":"丙谷胺"},"da_an":"C","typeid":"117","time":"2018-09-13 14:52:45","xiang_jie":"[答案]C\r\n[考点]重症胃食管反流病的治疗\r\n[考点还原]（P359）\u201c2.抑酸药\u2026（1）PPI\u2026适用于症状重、有严重食管炎的患者\u201d（C对）。\r\n[解析]重症胃食管反流病需要强的抑酸药治疗，题中所列五种药物中奥美拉唑的抑酸作用最强，因此宜首选，其余多适用于轻、中症病人。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"530","all_num":"542","types":0,"pname":"内科学"},{"id":"3636","name":"十二指肠溃疡的发病主要是因为：","data":{"A":"胃酸、胃蛋白酶等侵袭因素增强","B":"黏膜屏障减弱","C":"黏膜血流量减低","D":"细胞更新能力减弱","E":"表皮生长因子减少\t"},"da_an":"A","typeid":"117","time":"2018-09-13 14:53:30","xiang_jie":"[答案]A\r\n[考点]十二指肠溃疡的发病机制\r\n[考点还原]（P369）\u201c但胃溃疡在发病机制上以黏膜屏障功能降低为主要机制，十二指肠球部溃疡则以高胃酸分泌起主导作用\u201d（A对B错）。\r\n[解析]消化性溃疡的发生是由于胃酸、胃蛋白酶等侵袭因素增强和/或防御、修复因素减弱所致，十二指肠溃疡的发生主要以前者为主，而胃溃疡的发生主要以后者为主。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"531","all_num":"552","types":0,"pname":"内科学"},{"id":"3638","name":"下列不符合肠易激综合征腹泻特点的是：","data":{"A":"一般每日大便3〜5次","B":"大便多呈稀糊状","C":"大便多带有黏液","D":"排便常干扰睡眠","E":"大便绝对无脓血"},"da_an":"D","typeid":"117","time":"2018-09-13 14:54:47","xiang_jie":"[答案]D\r\n[考点]肠易激综合征的腹泻特点\r\n[考点还原]（P400）\u201c【临床表现】\u2026极少有睡眠中痛醒者\u201d（D错，为本题正确答案）。（P400）\u201c【临床表现】\u2026腹泻型IBS常排便较急，粪便呈糊状或稀水样（B对），一般每日3～5次左右（A对），少数严重发作期可达十余次，可带有黏液（C对），但无脓血（E对）\u201d。\r\n[解析]肠易激综合征是一种功能性肠道疾病，一般每日大便3〜5次左右，大便多呈糊状，多带有黏液，绝对无脓血，排便不影响睡眠，故答案是D。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"502","all_num":"559","types":0,"pname":"内科学"},{"id":"3639","name":"隐性肝性脑病病人的临床特点是：","data":{"A":"轻度性格改变","B":"轻度行为改变","C":"应答尚准确，但吐字稍缓慢","D":"可有扑翼样震颤","E":"无任何临床表现\t"},"da_an":"E","typeid":"117","time":"2018-08-05 21:35:50","xiang_jie":"[答案]E\r\n[考点]肝性脑病的临床表现\r\n[考点还原]（P435）\u201c0期（潜伏期） 又称轻微肝性脑病，无行为、性格异常（AB错），无神经系统病理征，脑电图正常，只在心理测试或智力测试时有轻微异常（E对CD错）\u201d。\r\n[解析]隐性肝性脑病亦称亚临床肝性脑病，无任何临床表现，而其他四种表现均是一期（前驱期）肝性脑病的临床表现。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"435","all_num":"541","types":0,"pname":"内科学"},{"id":"3640","name":"急性胰腺炎治疗时，下列属抑制胰酶活性的药物是：","data":{"A":"抑肽酶","B":"胰升糖素","C":"降钙素","D":"生长抑素","E":"奥曲肽"},"da_an":"A","typeid":"117","time":"2018-09-13 14:55:47","xiang_jie":"[答案]A\r\n[考点]急性胰腺炎的治疗\r\n[考点还原]（P443）\u201c天然生长抑素由胃肠黏膜D细胞合成，它可抑制胰泌素和缩胆囊素刺激的胰液基础分泌。急性胰腺炎时，循环中生长抑素水平显著降低，可予外源性补充生长抑素（D错）250～500μg/h，或生长抑素类似物奥曲肽（E错）25～50μg/h\u201d。\r\n[解析]急性胰腺炎的治疗，特别是出血坏死型胰腺炎早期的治疗需要抑制胰酶活性的药物，抑肽酶属于此类药物，而其余均为抑制胰液分泌的药物。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"410","all_num":"566","types":0,"pname":"内科学"},{"id":"3642","name":"诊断反流性食管炎最准确的方法是：","data":{"A":"食管吞钡X线检查","B":"食管滴酸试验","C":"食管内镜检查","D":"食管24小时pH值监测","E":"食管测压"},"da_an":"C","typeid":"117","time":"2018-09-13 14:56:44","xiang_jie":"[答案]C\r\n[考点]反流性食管炎的辅助检查\r\n[考点还原]（P358）\u201c（一）胃镜  是诊断RE最准确的方法，并能判断RE的严重程度和有无并发症\u201d（C对）。\r\n[解析]食管内镜检查是诊断反流性食管炎最准确的方法，不但可以确定诊断，并能判断反流性食管炎的严重程度和有无并发症，结合活检还可以与其他原因引起的食管炎和其他食管病变进行鉴别。而其他各项检查对诊断虽亦有帮助，但均不是最准确的诊断方法。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"514","all_num":"546","types":0,"pname":"内科学"},{"id":"3645","name":"下列关于消化性溃疡并发出血的叙述，正确的是：","data":{"A":"胃溃疡一般比十二指肠溃疡容易发生","B":"一般出血50〜100ml即可出现黑便","C":"出血超过500ml时就可引起循环障碍","D":"半小时内出血超过1000ml时均会发生休克","E":"第一次出血后很少复发\t"},"da_an":"B","typeid":"117","time":"2018-09-13 14:58:04","xiang_jie":"[答案]B\r\n[考点]消化性溃疡的出血并发症\r\n[考点还原]（P371）\u201c（一）出血\u2026十二指肠球部溃疡较胃溃疡易发生\u201d（A错）。（P371）\u201c表4-5-2  消化性溃疡出血的Forrest分型\u201d（E错）。（P453）\u201c成人每日消化道出血＞5ml，粪便潜血试验即出现阳性；每日出血量超过50ml可出现黑粪（B对）；胃内积血量＞250ml可引起呕血。一次出血量＜400ml时，因轻度血容量减少可由组织液及脾脏贮血所补充，多不引起全身症状。出血量＞400ml，可出现头昏、心悸、乏力等症状（C错）。短时间内出血量＞1000ml，可出现休克表现（D错）\u201d。\r\n[解析]出血是消化性溃疡很常见的并发症，一般十二指肠溃疡较胃溃疡易发生，一般出血达50〜100ml即可出现黑便，超过1000ml时可引起循环障碍，在半小时内出血超过1500ml时会发生休克，第一次出血后约40%可以复发，因此只有B是正确的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"452","all_num":"552","types":0,"pname":"内科学"},{"id":"3647","name":"下列关于肠结核腹泻特点的叙述错误的是：","data":{"A":"腹泻是溃疡型肠结核的主要表现之一","B":"一般不含黏液和脓液","C":"腹泻可与便秘交替","D":"常伴里急后重","E":"便血极少见"},"da_an":"D","typeid":"117","time":"2018-09-13 14:58:49","xiang_jie":"[答案]D\r\n[考点]肠结核的腹泻特点\r\n[考点还原]（P379）\u201c溃疡型肠结核常伴腹泻（A对），粪便呈糊状，多无脓血（BE对），不伴里急后重（D错，为本题正确答案）。有时腹泻与便秘交替（C对）。增生型肠结核以便秘为主\u201d。（P380）\u201c并发症见于晚期患者，以肠梗阻及合并结核性腹膜炎多见，瘘管、腹腔脓肿、肠出血（E对）少见\u201d。\r\n[解析]腹泻是肠结核（溃疡型）的主要临床表现之一，粪便呈糊状，一般不含黏液和脓液，不伴里急后重，便血极少见。腹泻与便秘交替是本病的临床特征，当然也可见于其他胃肠功能紊乱疾病。从上述看，肠结核常伴里急后重是错误的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"448","all_num":"537","types":0,"pname":"内科学"},{"id":"3650","name":"肝硬化最常见的并发症是：","data":{"A":"肝性脑病","B":"自发性腹膜炎","C":"上消化道出血","D":"肝肾综合征","E":"原发性肝癌"},"da_an":"C","typeid":"117","time":"2018-09-13 14:59:24","xiang_jie":"[答案]C\r\n[考点]肝硬化的并发症\r\n[考点还原]（七版内科学P449）\u201c（一）食管胃底静脉曲张破裂出血  为最常见的并发症\u201d（C对）。\r\n[解析]题中所列五项均为肝硬化的并发症，其中最严重的并发症是肝性脑病，但最常见的并发症是上消化道出血，多突然发生大量呕血或黑便，其余各项均相对少见。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"467","all_num":"534","types":0,"pname":"内科学"},{"id":"3651","name":"慢性胰腺炎后期，由于胰腺内分泌功能不全可引起：","data":{"A":"脂肪泻","B":"夜盲症","C":"Vit K缺乏症","D":"Vit D缺乏症","E":"糖尿病"},"da_an":"E","typeid":"117","time":"2018-09-13 15:00:16","xiang_jie":"[答案]E\r\n[考点]慢性胰腺炎的临床表现\r\n[考点还原]（P446）\u201c3.胰腺内分泌功能不全的表现  由于慢性胰腺炎引起胰腺β细胞破坏，半数患者可发生糖尿病\u201d（E对）。（P446）\u201c2.胰腺外分泌功能不全的表现  慢性胰腺炎后期，由于胰腺外分泌功能障碍可引起食欲减退、食后上腹饱胀，消瘦，营养不良，水肿，及维生素A（B错）、D（D错）、E、K（C错）缺乏等症状。部分患者由于胰腺外分泌功能明显不足而出现腹泻，大便每日3～4次，色淡、量多、有气泡。恶臭，大便内脂肪量增多（A错）并有不消化的肌肉纤维\u201d。\r\n[解析]慢性胰腺炎后期，可以出现胰腺功能不全表现，由于胰腺外分泌功能障碍可引起脂肪泻、夜盲症、Vit K缺乏症和Vit D缺乏症，约半数的慢性胰腺炎病人可因胰腺内分泌功能不全发生糖尿病。因此本题E是正确答案。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"326","all_num":"552","types":0,"pname":"内科学"},{"id":"3653","name":"下列用于胃食管反流病维持治疗的药物中，效果最好的是：","data":{"A":"西沙必利","B":"吗丁啉（多潘立酮）","C":"氢氧化铝","D":"西咪替丁","E":"奥美拉唑"},"da_an":"E","typeid":"117","time":"2018-09-13 15:01:04","xiang_jie":"[答案]E\r\n[考点]胃食管反流病的维持治疗\r\n[考点还原]（P359）\u201c（二）维持治疗\u2026PPI和H\u2082RA均可用于维持治疗，PPI效果更优\u201d（E对D错）。\r\n[解析]胃食管反流病具有慢性复发倾向，为减少症状复发，防止食管炎反复复发引起的并发症，需给予维持治疗，题中的五种药物均可用于维持治疗，西沙必利和吗丁啉（多潘立酮）是促胃动力药，氢氧化铝是碱性抗酸药，西咪替丁是H2受体拮抗剂，奥美拉唑是质子泵抑制剂，其中奥美拉唑抑酸作用强，维持治疗效果最好，所以答案是E。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"518","all_num":"530","types":0,"pname":"内科学"},{"id":"3656","name":"在慢性胃炎的发病机制中，与幽门螺杆菌感染无关的因素是：","data":{"A":"产生胃壁细胞抗体","B":"分泌空泡毒素A","C":"释放尿素酶分解尿素产生NH3","D":"产生细胞毒素相关基因蛋白","E":"菌体胞壁作为抗原诱导免疫反应"},"da_an":"A","typeid":"117","time":"2018-09-13 15:01:36","xiang_jie":"[答案]A\r\n[考点]幽门螺杆菌感染在慢性胃炎发病中的作用\r\n[考点还原]（P364）\u201cHp产生的尿素酶可分解尿素，产生的氨可中和反渗入黏液内的胃酸，形成有利于Hp定居和繁殖的局部微环境，使感染慢性化\u201d（C对）。（P364）\u201cHp凭借其产生的氨及空泡毒素导致细胞损伤；促进上皮细胞释放炎症介质；菌体细胞壁Lewis X、Lewis Y抗原引起自身免疫反应\u201d（BE对）。（七版内科学P383）\u201c其细胞毒素相关基因（cagA）蛋白能引起强烈的炎症反应\u201d（D对）。\r\n解析]胃壁细胞抗体是人体内的自身抗体，引起自身免疫性胃炎，即A型胃炎，而幽门螺杆菌感染是引起B型胃炎，除选项A外的其余四项均与幽门螺杆菌感染有关，幽门螺杆菌是通过这四项引起慢性胃炎的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"436","all_num":"529","types":0,"pname":"内科学"},{"id":"3658","name":"下列关于结核性腹膜炎全身症状的叙述，错误的是：","data":{"A":"主要症状是发热和盗汗","B":"热型以低热和中等热量多","C":"约1/3患者呈弛张热","D":"少数可呈稽留热","E":"毒血症状明显者见于粘连型"},"da_an":"E","typeid":"117","time":"2018-09-13 15:02:06","xiang_jie":"[答案]E\r\n[考点]结核性腹膜炎的临床表现\r\n[考点还原]（七版内科学P406）\u201c结核毒血症常见，主要是发热与盗汗（A对）。热型以低热与中等热为最多（B对），约1/3患者有弛张热（C对），少数可呈稽留热（D对）。高热伴有明显毒血症主要见于渗出型、干酪型，或见于伴有粟粒型肺结核、干酪样肺炎等严重结核病的患者（E错，为本题正确答案）\u201d。\r\n[解析]结核性腹膜炎的全身结核毒血症状常见，主要是发热与盗汗，热型以低热和中等热最多，约1/3患者有弛张热，少数可呈稽留热，毒血症状明显者主要见于渗出型、干酪型或见于伴有粟粒型肺结核、干酪样肺炎等严重结核病的患者，不见于粘连型患者，因此E项是错误的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"476","all_num":"550","types":0,"pname":"内科学"},{"id":"3723","name":"不支持肠易激综合征诊断的临床表现是：","data":{"A":"每天排便多于3次","B":"每周排便少于3次","C":"块状/硬粪便","D":"稀水样便","E":"粪便排出顺利，无不尽感\t"},"da_an":"E","typeid":"117","time":"2018-09-13 15:03:09","xiang_jie":"[答案]E\r\n[考点]肠易激综合征的诊断\r\n[考点还原]（P400）\u201c【诊断和鉴别诊断】\u2026以下症状不是诊断所必备，但属常见症状，这些症状越多越支持IBS的诊断：①排便频率异常（每天排便＞3次或每周＜3次）（AB对）；②粪便性状异常（块状/硬便或稀水样便）（CD对）；③粪便排出过程异常（费力、急迫感、排便不尽感）（E错，为本题正确答案）；④黏液便；⑤胃肠胀气或腹部膨胀感\u201d。\r\n[解析]以下临床表现支持肠易激综合征的诊断：①排便频率异常（每天排便＞3次或每周＜3次）；②粪便性状异常（块状/硬便或稀水样便）；③粪便排出过程异常（费力、急迫感、排便不尽感）；④黏液便；⑤胃肠胀气或腹部膨胀感。因此答案是E。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"434","all_num":"528","types":0,"pname":"内科学"},{"id":"3730","name":"男性，25岁，右下腹痛3月余，还常伴有上腹或脐周腹痛，排便次数稍多，呈糊状，不含黏液和脓血，每日2〜4次，曾作过X线钡剂检查发现回盲部有跳跃征。最可能的诊断是：","data":{"A":"克罗恩病","B":"溃疡型肠结核","C":"右侧结肠癌","D":"阿米巴病","E":"肠恶性淋巴瘤\t"},"da_an":"B","typeid":"117","time":"2018-09-13 16:07:25","xiang_jie":"[考点]肠结核的诊断和鉴别诊断\r\n[考点还原]（P379）\u201c（一）腹痛  多位于右下腹或脐周\u201d（P379）\u201c（二）大便习惯改变  溃疡型肠结核常伴腹泻，粪便呈糊状，多无脓血\u201d（P380）\u201c溃疡型肠结核，钡剂于病变肠段呈现激惹征象，排空很快，充盈不佳，而在病变的上、下肠段则钡剂充盈良好，称为X线钡剂激惹征\u201d（B对）。\r\n[解析]本例年轻患者有慢性右下腹痛病史，排便次数稍多，题中列出的五种疾病均有可能，但X线钡剂检查发现回盲部有跳跃征，这是溃疡型肠结核的典型X线表现，所以该患者最可能的诊断是溃疡型肠结核。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"440","all_num":"526","types":0,"pname":"内科学"},{"id":"3734","name":"男性，40岁，健康体检时化验血甲胎蛋白＞500μg/L，血ALT 35U/U查体未见异常。初步诊断最可能是：","data":{"A":"肝硬化代偿期","B":"肝硬化失代偿期","C":"慢性迁延性肝炎","D":"慢性活动性肝炎","E":"亚临床肝癌"},"da_an":"E","typeid":"117","time":"2018-09-13 15:04:03","xiang_jie":"[考点]原发性肝癌的诊断\r\n[考点还原]（P431）\u201c在排除妊娠和生殖腺胚胎瘤的基础上，AFP＞400ng/ml为诊断肝癌的条件之一\u201d（七版内科学P459）\u201c如AFP呈低浓度阳性持续达2个月甚至更久，ALT正常，应特别警惕亚临床肝癌的存在\u201d（七版内科学P460）\u201c【诊断】\u2026经普查检出的肝癌可无任何症状和体征，称为亚临床肝癌\u201d（E对）。\r\n[解析]本例中年男性患者在健康体检时化验血发现甲胎蛋白明显增高（＞500μg/L），而肝功能正常，查体未见异常，因此不支持肝硬化和肝炎的诊断，而原发性肝癌起病隐匿，早期缺乏典型临床表现，经甲胎蛋白普查检出的早期病例可无任何症状和体征，称为亚临床肝癌，因此答案是E","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"434","all_num":"504","types":0,"pname":"内科学"},{"id":"3738","name":"在用糖皮质激素治疗溃疡性结肠炎时，宜选用主要作用于肠道局部而全身不良反应较小的类型。下列具有此种作用的糖皮质激素是：","data":{"A":"泼尼松","B":"泼尼松龙","C":"布地奈德","D":"地塞米松","E":"琥珀酸钠氢化可的松"},"da_an":"C","typeid":"117","time":"2018-09-13 15:04:47","xiang_jie":"[考点]溃疡性结肠炎的糖皮质激素治疗\r\n[考点还原]（P389）\u201c病变局限于直肠者也可用布地奈德泡沫灌肠剂2mg保留灌肠，每晚1次，该药是以局部作用为主的糖皮质激素，故全身不良反应较少\u201d（C对）。\r\n[解析]糖皮质激素对急性发作期的溃疡性结肠炎有较好疗效，但多数糖皮质激素如泼尼松、泼尼松龙、地塞米松、琥珀酸钠氢化可的松等都是全身起作用，所以全身的不良反应较大，而布地奈德为新型糖皮质激素，主要在肠道局部起作用，所以全身不良反应大大减少。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"418","all_num":"522","types":0,"pname":"内科学"},{"id":"3744","name":"目前，对肠易激综合征的诊断推荐采用国际认同的罗马Ⅱ标准，其中有关腹部不适或腹痛时间的规定是在过去12个月内至少累计达","data":{"A":"6周","B":"8周","C":"10周","D":"12周","E":"16周"},"da_an":"D","typeid":"117","time":"2018-09-13 15:05:34","xiang_jie":"[考点还原]  八版内科学未明确说明。\r\n[解析]这是道记忆题。目前对肠易激综合征的诊断推荐采用国际认同的罗马Ⅱ标准，其中有关腹部不适或腹痛时间的规定是在过去12个月内至少累计达12周。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"377","all_num":"522","types":0,"pname":"内科学"},{"id":"3746","name":"在肝硬化的发病机制中，形成肝纤维化的主要细胞是","data":{"A":"肝星状细胞","B":"肝细胞","C":"Kupffer细胞","D":"上皮细胞","E":"内皮细胞"},"da_an":"A","typeid":"117","time":"2018-09-13 15:06:23","xiang_jie":"[考点]肝硬化时的肝纤维化形成\r\n[考点还原]（七版内科学P447）\u201c肝星状细胞（A对）是形成肝纤维化的主要细胞\u201d。\r\n[解析]近年来对肝硬化时的肝纤维化形成有较为深入的研究，如果肝的纤维组织形成增多而降解减少则可导致肝纤维化，肝星状细胞是形成纤维化的主要细胞，使胶原合成增多，此外肝细胞和Kupffer细胞亦有合成胶原的功能，而上皮细胞和内皮细胞则不会，因此答案是A。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"467","all_num":"522","types":0,"pname":"内科学"},{"id":"3750","name":"近年来开展的经颈静脉肝内门体分流术治疗肝硬化门脉高压症，其最大副作用是易诱发：","data":{"A":"肝肾综合征","B":"肝肺综合征","C":"肝性脑病","D":"感染","E":"电解质和酸碱平衡紊乱\t"},"da_an":"C","typeid":"117","time":"2018-09-13 15:07:24","xiang_jie":"[考点]肝硬化门脉高压症的颈静脉肝内门体分流术治疗\r\n[考点还原]（P441）\u201c其主要问题是支撑管可进行性狭窄和并发肝功能衰竭（5%～10%），肝性脑病（20%～40%）\u201d。\r\n[解析]近年来开展的颈静脉肝内门体分流术是一种以介入放射学的方法在肝内的门静脉与肝静脉的主要分支间建立通道，能有效降低门静脉压力，创伤小，安全性高，适用于食管静脉曲张大出血和难治性腹水，但易诱发肝性脑病，这是此疗法最大的副作用。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"479","all_num":"508","types":0,"pname":"内科学"},{"id":"3754","name":"下列选项中，属于胰腺外分泌功能的试验是","data":{"A":"维生素B12吸收试验","B":"胰功肽试验","C":"血清缩胆囊素测定","D":"空腹血浆胰岛素测定","E":"血浆胰多肽测定"},"da_an":"B","typeid":"117","time":"2018-08-06 10:51:02","xiang_jie":"[考点]测定胰腺外分泌功能的试验\r\n[考点还原]（七版内科学P477）\u201c（一）胰腺外分泌功能试验（B对） 1.直接刺激试验  胰泌素可刺激胰腺腺泡分泌胰液和碳酸氢钠\u20262.间接刺激试验  ①Lundh试验\u2026②胰功肽试验（粪弹力蛋白酶）\u2026（二）吸收功能试验  1.粪便（72小时）脂肪检查\u20262.维生素B\u2081\u2082吸收试验\u2026（四）胰腺内分泌测定  1.血清缩胆囊素\u20262.血浆胰多肽\u20263.空腹血浆胰岛素水平\u201d。\r\n[解析]测定胰腺外分泌功能的试验包括直接刺激试验和间接刺激试验两大类，选项中的胰功肽试验是属于间接刺激试验，而维生素Bl2吸收试验是属于胰腺的吸收功能试验，其余三个选项均属于胰腺内分泌功能测定试验。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"263","all_num":"551","types":0,"pname":"内科学"},{"id":"3758","name":"男性，30岁，患消化性溃疡2年余，经常反复发作，曾用过多种药物治疗。下列用过的治疗药物中，属于保护胃黏膜的药物是：","data":{"A":"法莫替丁","B":"奥美拉唑","C":"氢氧化铝","D":"西沙必利","E":"米索前列醇"},"da_an":"E","typeid":"117","time":"2018-09-13 15:08:33","xiang_jie":"[考点]消化性溃疡的药物治疗\r\n[考点还原]（P373）\u201c3.保护胃黏膜\u2026（2）弱碱性抗酸剂：常用铝碳酸镁、磷酸铝、硫糖铝、氢氧化铝凝胶等\u2026碱性抗酸剂目前更多被视为粘膜保护剂\u201d（C）。（七版内科学P393）\u201c2.保护胃黏膜药物\u2026米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用，主要用于NSAID溃疡的预防\u201d（E对）。\r\n[解析]治疗消化性溃疡的药物可分为抑制胃酸的药物和保护胃黏膜的药物两大类，保护胃黏膜的药物包括硫糖铝、米索前列醇和枸橼酸铋钾等，因此答案是E。其余除西沙必利是属于胃肠动力药外，均为抑制胃酸的药物。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"427","all_num":"522","types":0,"pname":"内科学"},{"id":"3761","name":"男性，35岁，腹泻伴左下腹轻至中度疼痛2年，每天大便4〜5次，间断便血，有疼痛\u2014便意\u2014便后缓解的规律，常有里急后重，最近结肠镜检查发现结肠黏膜粗糙呈细颗粒状，血管纹理模糊。目前最可能的诊断是","data":{"A":"肠道功能紊乱","B":"克罗恩病","C":"溃疡性结肠炎","D":"肠阿米巴病","E":"肠结核"},"da_an":"C","typeid":"117","time":"2018-09-13 15:09:21","xiang_jie":"[考点]溃疡性结肠炎的诊断\r\n[考点还原]（P385）\u201c本病可发生在任何年龄，多见于20～40岁\u201d（P386）\u201c1.腹泻和黏液脓血便\u2026黏液脓血便是本病活动期的重要表现\u201d（P386）\u201c2.腹痛  多有轻至中度腹痛，为左下腹或下腹阵痛，亦可累及全腹。常有里急后重，便后腹痛缓解\u201d（P387）\u201c（四）结肠镜\u2026内镜下所见黏膜改变有：①黏膜血管纹理模糊、紊乱或消失、充血、水肿、易脆、出血及脓性分泌物附着；②病变明显处见弥漫性糜烂和多发性浅溃疡；③慢性病变常见黏膜粗糙、呈细颗粒状，炎性息肉及桥状黏膜\u201d（C对）。\r\n[解析]该例中年男性患者是左下腹痛、腹泻，临床表现中的疼痛\u2014便意\u2014便后缓解的规律和结肠镜检查的发现均支持溃疡性结肠炎的诊断。而克罗恩病、肠阿米巴病和肠结核的病变均在右下腹，不会有左下腹痛和相应表现。肠道功能紊乱的表现多与此不同，而且结肠镜检查不会有异常。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"476","all_num":"507","types":0,"pname":"内科学"},{"id":"3770","name":"铅中毒时的解毒药物是：","data":{"A":"依地酸钠钙","B":"二巯丙醇","C":"纳洛酮","D":"亚甲蓝"},"da_an":"A","typeid":"117","time":"2018-08-06 10:56:13","xiang_jie":"[考点]急性中毒的解毒药物治疗\r\n   [考点还原]（P881）\u201c表9-2-5毒物络合剂的应用\u201d（A对）                                                    [解析]铅中毒时的解毒药物是依地酸钠钙；阿片类麻醉药中毒的解毒药物是纳洛酮。二巯丙醇是砷、汞、锑中毒的解毒药物；亚甲蓝是亚硝酸盐、苯胺、硝基苯等中毒引起的高铁血红蛋白血症的解毒药物。                                                       ","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"360","all_num":"458","types":0,"pname":"内科学"},{"id":"3772","name":"阿片类麻醉药中毒时的解毒药物是","data":{"A":"依地酸钠钙","B":"二巯丙醇","C":"纳洛酮","D":"亚甲蓝"},"da_an":"C","typeid":"117","time":"2018-09-13 15:10:29","xiang_jie":" [考点还原]（P882）\u201c1）纳洛酮：是阿片类麻醉药的解毒药，对麻醉镇痛药引起的呼吸抑制有特异性拮抗作用\u201d（C对）。\r\n[解析]铅中毒时的解毒药物是依地酸钠钙；阿片类麻醉药中毒的解毒药物是纳洛酮。二巯丙醇是砷、汞、锑中毒的解毒药物；亚甲蓝是亚硝酸盐、苯胺、硝基苯等中毒引起的高铁血红蛋白血症的解毒药物。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"403","all_num":"449","types":0,"pname":"内科学"},{"id":"3780","name":"在我国最易引起原发性肝癌的肝硬化类型是","data":{"A":"病毒性肝炎后肝硬化","B":"酒精性肝硬化","C":"淤血性肝硬化","D":"原发性胆汁性肝硬化"},"da_an":"A","typeid":"117","time":"2018-09-13 15:11:22","xiang_jie":"[考点]病毒性肝炎后肝硬化的并发症和体征\r\n[考点还原]（P429）\u201c在我国，肝癌患者中约90％有乙型肝炎病毒感染的背景。HBV感染→慢性肝炎→肝硬化→肝癌是最主要的发病机制\u201d（A对BCD错）。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"469","all_num":"490","types":0,"pname":"内科学"},{"id":"3783","name":"肝明显缩小的肝硬化类型是","data":{"A":"病毒性肝炎后肝硬化","B":"酒精性肝硬化","C":"淤血性肝硬化","D":"原发性胆汁性肝硬化"},"da_an":"A","typeid":"117","time":"2018-11-17 17:41:47","xiang_jie":"[考点还原]  八版内科学未明确说明。\r\n[解析]肝硬化是一种或多种病因长期或反复作用导致的肝组织弥漫性纤维化、再生结节和假小叶形成为特征的慢性肝病。慢性病毒性肝炎是我国肝硬化最常见的病因，原发性肝癌病人中约1/3有慢性病毒性肝炎史。所以在我国最易引起原发性肝癌的肝硬化类型是病毒性肝炎后肝硬化。肝明显缩小的肝硬化类型是病毒性肝炎后肝硬化。而其他类型的肝硬化（酒精性肝硬化、淤血性肝硬化和原发性胆汁性肝硬化）均为肝增大。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"435","all_num":"500","types":0,"pname":"内科学"},{"id":"3790","name":"消化性溃疡患者最常见的并发症是","data":{"A":"穿孔","B":"出血","C":"幽门梗阻","D":"癌变"},"da_an":"B","typeid":"117","time":"2018-09-13 15:12:59","xiang_jie":"[考点]消化性溃疡的并发症\r\n[考点还原]（七版内科学P391）\u201c出血（B对）是消化性溃疡最常见的并发症\u201d。                    [解析]消化性溃疡是指胃肠道黏膜被自身消化而形成的溃疡，常见并发症包括出血、穿孔、幽门梗阻和癌变，其中出血是消化性溃疡最常见的并发症。消化性溃疡又包括胃溃疡和十二指肠溃疡，十二指肠溃疡患者不易发生癌变并发症。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"460","all_num":"501","types":0,"pname":"内科学"},{"id":"3795","name":"十二指肠溃疡患者不易发生的并发症是","data":{"A":"穿孔","B":"出血","C":"幽门梗阻","D":"癌变"},"da_an":"D","typeid":"117","time":"2018-09-13 15:13:50","xiang_jie":"[考点]消化性溃疡的并发症                                                                                                        \r\n [考点还原]（P371）\u201c（四）癌变  溃疡由良性演变为恶性的几率很低，估计＜1％胃溃疡有可能癌变，十二指肠球部溃疡一般不发生癌变\u201d（D对）。\r\n[解析]消化性溃疡是指胃肠道黏膜被自身消化而形成的溃疡，常见并发症包括出血、穿孔、幽门梗阻和癌变，其中出血是消化性溃疡最常见的并发症。消化性溃疡又包括胃溃疡和十二指肠溃疡，十二指肠溃疡患者不易发生癌变并发症。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"483","all_num":"503","types":0,"pname":"内科学"},{"id":"3804","name":"侵入性检查幽门螺杆菌的首选方法是","data":{"A":"血清学检查","B":"13C尿素呼气试验","C":"胃组织学检查","D":"快速尿素酶试验"},"da_an":"D","typeid":"117","time":"2018-09-13 15:14:47","xiang_jie":"[考点]幽门螺杆菌的检查方法\r\n[考点还原]（七版内科学P533）\u201c快速尿素酶试验是侵入性检查的首选方法\u201d（C对）          \r\n [解析]幽门螺杆菌的检查方法有侵入性和非侵入性两类，其中侵入性方法包括快速尿素酶试验、胃组织学检查及细菌培养等，快速尿素酶试验是侵入性检查幽门螺杆菌的首选方法。当幽门螺杆菌根除治疗后复查疗效时，首选的检查方法是l3C尿素呼气试验，这是最常用的非侵入性检查幽门螺杆菌的方法，虽然血清学检查也是非侵入性检查幽门螺杆菌的方法，但由于该方法检查的是抗幽门螺杆菌的抗体，当幽门螺杆菌根除治疗后，幽门螺杆菌可能已被根除，但其抗体却不会随幽门螺杆菌根除而消失；另外当幽门螺杆菌根除治疗后复查疗效时，也不会选用侵入性检查幽门螺杆菌的方法。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"442","all_num":"510","types":0,"pname":"内科学"},{"id":"3807","name":"当幽门螺杆菌根除治疗后复查疗效时，首选的检查方法是","data":{"A":"血清学检查","B":"13C尿素呼气试验","C":"胃组织学检查","D":"快速尿素酶试验"},"da_an":"B","typeid":"117","time":"2018-08-06 11:06:11","xiang_jie":"[考点]幽门螺杆菌的检查方法                                                                                                     \r\n [考点还原]（七版内科学P533）\u201c¹³C或¹\u2074C尿素呼气试验检测幽门螺杆菌敏感性及特异性高而无需胃镜检查，可作为根除治疗后复查的首选方法\u201d（B对）。\r\n[解析]幽门螺杆菌的检查方法有侵入性和非侵入性两类，其中侵入性方法包括快速尿素酶试验、胃组织学检查及细菌培养等，快速尿素酶试验是侵入性检查幽门螺杆菌的首选方法。当幽门螺杆菌根除治疗后复查疗效时，首选的检查方法是l3C尿素呼气试验，这是最常用的非侵入性检查幽门螺杆菌的方法，虽然血清学检查也是非侵入性检查幽门螺杆菌的方法，但由于该方法检查的是抗幽门螺杆菌的抗体，当幽门螺杆菌根除治疗后，幽门螺杆菌可能已被根除，但其抗体却不会随幽门螺杆菌根除而消失；另外当幽门螺杆菌根除治疗后复查疗效时，也不会选用侵入性检查幽门螺杆菌的方法。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"483","all_num":"507","types":0,"pname":"内科学"},{"id":"3812","name":"克罗恩病患者最常见的并发症是","data":{"A":"肠穿孔","B":"肠出血","C":"肠梗阻","D":"中毒性巨结肠"},"da_an":"C","typeid":"117","time":"2018-09-13 15:15:46","xiang_jie":"[考点]炎症性肠病患者的并发症\r\n[考点还原]（P391）\u201c【并发症】 肠梗阻最常见，其次是腹腔内脓肿，偶可并发急性穿孔或大量便血\u201d（C对）。                                                                                                                   \r\n[解析]肠穿孔、肠出血、肠梗阻、中毒性巨结肠都是炎症性肠病的并发症，其中肠梗阻是克罗恩病患者最常见的并发症；中毒性巨结肠是暴发型或重型溃疡性结肠炎患者最易发生的并发症。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"446","all_num":"500","types":0,"pname":"内科学"},{"id":"3817","name":"暴发型或重型溃疡性结肠炎患者最易发生的并发症是","data":{"A":"肠穿孔","B":"肠出血","C":"肠梗阻","D":"中毒性巨结肠"},"da_an":"D","typeid":"117","time":"2018-09-13 15:16:15","xiang_jie":"[考点]炎症性肠病患者的并发症                                                                                                 \r\n [考点还原]（P387）\u201c（一）中毒性巨结肠  约5％的重症UC患者可出现中毒性巨结肠\u201d（D对）。\r\n[解析]肠穿孔、肠出血、肠梗阻、中毒性巨结肠都是炎症性肠病的并发症，其中肠梗阻是克罗恩病患者最常见的并发症；中毒性巨结肠是暴发型或重型溃疡性结肠炎患者最易发生的并发症。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"487","all_num":"505","types":0,"pname":"内科学"},{"id":"3821","name":"肝硬化代偿期的体征是","data":{"A":"黄疸","B":"肝大","C":"腹壁静脉曲张","D":"皮肤紫癜"},"da_an":"B","typeid":"117","time":"2018-09-13 15:17:23","xiang_jie":"[考点]肝硬化的临床表现\r\n[考点还原]（P421）\u201c（一）代偿期  大部分患者无症状或症状较轻，可有腹部不适、乏力、食欲减退、消化不良和腹泻等症状\u2026肝脏是否肿大取决于不同类型的肝硬化（B对）\u201d。（P421）\u201c（二）失代偿期 （3）黄疸（A错）\u2026（4）出血和贫血：常有鼻腔、牙龈出血及皮肤黏膜瘀点、瘀斑和消化道出血等（D错）\u201d。（P422）\u201c②腹壁静脉曲张\u201d（C错）。    \r\n [解析]肝硬化分为代偿期和失代偿期。肝硬化代偿期是肝硬化的早期阶段，可触及肿大的肝，即肝大。其余备选答案均为肝硬化失代偿期的表现，其中只有腹壁静脉曲张为肝硬化失代偿期门静脉高压的体征。黄疸提示肝功能储备已明显减退；皮肤紫癜为出血倾向，主要与肝合成凝血因子减少及脾功能亢进所致血小板减少有关。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"403","all_num":"502","types":0,"pname":"内科学"},{"id":"3827","name":"肝硬化失代偿期门脉高压的体征是","data":{"A":"黄疸","B":"肝大","C":"腹壁静脉曲张","D":"皮肤紫癜"},"da_an":"C","typeid":"117","time":"2018-09-13 15:18:06","xiang_jie":"[考点]肝硬化的临床表现                                                                                                            [考点还原]（P422）\u201c②腹壁静脉曲张\u201d（C对）。\r\n[解析]肝硬化分为代偿期和失代偿期。肝硬化代偿期是肝硬化的早期阶段，可触及肿大的肝，即肝大。其余备选答案均为肝硬化失代偿期的表现，其中只有腹壁静脉曲张为肝硬化失代偿期门静脉高压的体征。黄疸提示肝功能储备已明显减退；皮肤紫癜为出血倾向，主要与肝合成凝血因子减少及脾功能亢进所致血小板减少有关。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"485","all_num":"488","types":0,"pname":"内科学"},{"id":"3831","name":"肝性脑病二期的表现是","data":{"A":"扑翼样震颤无法引出","B":"轻度性格改变和行为失常","C":"昏睡和精神错乱","D":"意识错乱和睡眠倒错"},"da_an":"D","typeid":"117","time":"2018-09-13 15:18:46","xiang_jie":"[考点]肝性脑病的临床表现\r\n[考点还原]（P435）\u201c1期（前驱期） 轻度性格改变和精神异常\u201d（B错）。（P435）\u201c2期（昏迷前期）嗜睡、行为异常（如衣冠不整或随地大小便）、言语不清、书写障碍及定向力障碍\u201d（D对）。（P435）\u201c3期（昏睡期） 昏睡，但可唤醒，醒时尚能作答，常有神志不清或幻觉\u201d（C错）。（P435）\u201c4期（昏迷期） 昏迷，不能唤醒。患者不能合作而无法引出扑翼样震颤\u201d（A错）。                                                                                                                   \r\n [解析]根据肝性脑病的临床表现，肝性脑病分为四期：一期（前驱期）表现为轻度性格改变和行为失常，可引出扑翼样震颤；二期（昏迷前期）表现为意识错乱和睡眠倒错，可引出扑翼样震颤；三期（昏睡期）表现为昏睡和精神错乱，仍可引出扑翼样震颤；四期（昏迷期）扑翼样震颤无法引出。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"404","all_num":"497","types":0,"pname":"内科学"},{"id":"3838","name":"肝性脑病四期的表现是","data":{"A":"扑翼样震颤无法引出","B":"轻度性格改变和行为失常","C":"昏睡和精神错乱","D":"意识错乱和睡眠倒错"},"da_an":"A","typeid":"117","time":"2018-09-13 15:19:23","xiang_jie":"[考点]肝性脑病的临床表现                                                                                                         \r\n[考点还原]（P435）\u201c1期（前驱期） 轻度性格改变和精神异常\u201d（B错）。（P435）\u201c2期（昏迷前期） 嗜睡、行为异常（如衣冠不整或随地大小便）、言语不清、书写障碍及定向力障碍\u201d（D错）。（P435）\u201c3期（昏睡期） 昏睡，但可唤醒，醒时尚能作答，常有神志不清或幻觉\u201d（C错）。（P435）\u201c4期（昏迷期） 昏迷，不能唤醒。患者不能合作而无法引出扑翼样震颤\u201d（A对）。\r\n[解析]根据肝性脑病的临床表现，肝性脑病分为四期：一期（前驱期）表现为轻度性格改变和行为失常，可引出扑翼样震颤；二期（昏迷前期）表现为意识错乱和睡眠倒错，可引出扑翼样震颤；三期（昏睡期）表现为昏睡和精神错乱，仍可引出扑翼样震颤；四期（昏迷期）扑翼样震颤无法引出。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"467","all_num":"501","types":0,"pname":"内科学"},{"id":"3845","name":"治疗肝性脑病时，可减少假神经递质形成的药物是：","data":{"A":"精氨酸","B":"谷氨酸钾","C":"支链氨基酸","D":"乳果糖"},"da_an":"C","typeid":"117","time":"2018-08-06 11:14:41","xiang_jie":"[考点]肝性脑病的治疗\r\n[考点还原]（P436-P437）\u201c（三）减少肠内氮源性毒物的生成与吸收\u20262.乳果糖（D错）或乳梨醇\u201d。（P437）\u201c（四）促进体内氨的代谢\u20263.其他  谷氨酸钠或钾（B错）、精氨酸（A错）等药物理论上具有降血氨作用\u201d。（P437）\u201c2.减少或拮抗假性神经递质  支链氨基酸（C对）制剂是一种以亮氨酸、异亮氨酸、缬氨酸等为主的复合氨基酸。其机制为竞争性抑制芳香族氨基酸进入大脑，减少假性神经递质的形成\u201d。                                                               \r\n [解析]支链氨基酸制剂是一种以亮氨酸、异亮氨酸、缬氨酸为主的复合氨基酸，可竞争性抑制芳香族氨基酸进入大脑，减少假神经递质的形成。乳果糖在结肠可被乳酸杆菌、粪肠球菌等细菌分解成乳酸、乙酸而降低肠道的pH值，肠道酸化后对产尿素酶的细菌生长不利，但有利于不产尿素酶的乳酸杆菌生长，使肠道细菌产氨减少；酸性的肠道环境可减少氨的吸收，并促进血液中的氨渗入肠道排出。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"383","all_num":"519","types":0,"pname":"内科学"},{"id":"3851","name":"治疗肝性脑病时，可减少氨生成与吸收的药物是：","data":{"A":"精氨酸","B":"谷氨酸钾","C":"支链氨基酸","D":"乳果糖"},"da_an":"D","typeid":"117","time":"2018-09-13 15:20:26","xiang_jie":"[考点]肝性脑病的治疗                                                                                                                \r\n [考点还原]（P436-P437）\u201c（三）减少肠内氮源性毒物的生成与吸收\u20262.乳果糖或乳梨醇  乳果糖是一种合成的双糖，口服后在小肠不被分解，到达结肠后可被乳酸杆菌、粪肠球菌等细菌分解为乳酸、乙酸而降低肠道的pH值。肠道酸化后对产尿素酶的细菌生长不利，但有利于不产尿素酶的乳酸杆菌生长，使肠道细菌产氨减少；此外，酸性的肠道环境可减少氨的吸收，并促进血液中的氨渗入肠道排出体外\u201d（D对）。（P437）\u201c2.减少或拮抗假性神经递质  支链氨基酸（C错）制剂是一种以亮氨酸、异亮氨酸、缬氨酸等为主的复合氨基酸。其机制为竞争性抑制芳香族氨基酸进入大脑，减少假性神经递质的形成\u201d。（P437）\u201c（四）促进体内氨的代谢\u2026谷氨酸钠或钾（B错）、精氨酸（A错）等药物理论上具有降血氨作用\u201d。\r\n[解析]支链氨基酸制剂是一种以亮氨酸、异亮氨酸、缬氨酸为主的复合氨基酸，可竞争性抑制芳香族氨基酸进入大脑，减少假神经递质的形成。乳果糖在结肠可被乳酸杆菌、粪肠球菌等细菌分解成乳酸、乙酸而降低肠道的pH值，肠道酸化后对产尿素酶的细菌生长不利，但有利于不产尿素酶的乳酸杆菌生长，使肠道细菌产氨减少；酸性的肠道环境可减少氨的吸收，并促进血液中的氨渗入肠道排出。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"335","all_num":"552","types":0,"pname":"内科学"},{"id":"3857","name":"夜间痛多见且易并发出血的溃疡是","data":{"A":"无症状性溃疡","B":"幽门管溃疡","C":"复合性溃疡","D":"球后溃疡"},"da_an":"D","typeid":"117","time":"2018-09-13 15:21:12","xiang_jie":"[考点]四种特殊类型消化性溃疡的特点\r\n[考点还原]（七版内科学P390）\u201c（三）球后溃疡\u2026具有DU的临床特点，但午夜痛及背部放射痛多见，对药物治疗反应较差，较易并发出血\u201d（D对）。                                                 \r\n[解析]球后溃疡多发生在十二指肠乳头的近端，其临床特点是夜间痛多见且易并发出血，所以夜间痛多见且易并发出血的溃疡是球后溃疡；约15%消化性溃疡患者临床可无症状，称为无症状性溃疡，以老年人多见，NSAID引起的溃疡近半数无症状，用H2RA维持治疗过程中，复发的溃疡半数以上也是无症状性溃疡。而幽门管溃疡发生在胃远端，较易发生幽门梗阻、出血和穿孔等并发症；复合性溃疡是指胃和十二指肠同时发生的溃疡，幽门梗阻发生率较高。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"482","all_num":"543","types":0,"pname":"内科学"},{"id":"3861","name":"用H2RA维持治疗过程中，复发的溃疡半数以上是","data":{"A":"无症状性溃疡","B":"幽门管溃疡","C":"复合性溃疡","D":"球后溃疡"},"da_an":"A","typeid":"117","time":"2018-09-13 15:21:54","xiang_jie":"[考点]四种特殊类型消化性溃疡的特点                                                                                     \r\n[考点还原]（五版内科学P403）\u201c用H\u2082受体拮抗剂（H\u2082RA）维持治疗中复发的溃疡半数以上为无症状溃疡\u201d（A对）。\r\n[解析]球后溃疡多发生在十二指肠乳头的近端，其临床特点是夜间痛多见且易并发出血，所以夜间痛多见且易并发出血的溃疡是球后溃疡；约15%消化性溃疡患者临床可无症状，称为无症状性溃疡，以老年人多见，NSAID引起的溃疡近半数无症状，用H2RA维持治疗过程中，复发的溃疡半数以上也是无症状性溃疡。而幽门管溃疡发生在胃远端，较易发生幽门梗阻、出血和穿孔等并发症；复合性溃疡是指胃和十二指肠同时发生的溃疡，幽门梗阻发生率较高。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"282","all_num":"575","types":0,"pname":"内科学"},{"id":"3866","name":"治疗轻、中型溃疡性结肠炎的首选药物是","data":{"A":"柳氮磺吡啶","B":"美沙拉嗪","C":"布地奈德","D":"硫唑嘌呤"},"da_an":"A","typeid":"117","time":"2018-09-13 15:23:22","xiang_jie":"[考点]炎症性肠病（溃疡性结肠炎和克罗恩病）的治疗\r\n[考点还原]（P389）\u201c（1）柳氮磺吡啶（SASP）：治疗轻、中度或经糖皮质激素治疗已有缓解的重度UC常用药物\u201d（A对）                                                                                              \r\n[解析]溃疡性结肠炎和克罗恩病均属于炎症性肠病。溃疡性结肠炎是一种病因尚不十分清楚的直肠和结肠慢性非特异性炎症性疾病，治疗轻、中型溃疡性结肠炎的首选药物是柳氮磺吡啶，柳氮磺吡啶口服后，经肠菌分解为5-氨基水杨酸（5-ASA）发挥作用，也可用于重型经糖皮质激素治疗已有缓解者。克罗恩病是一种病因尚不十分清楚的肠道慢性炎性肉芽肿性疾病，病变多见于远端回肠和结肠，美沙拉嗪是5-ASA的新型制剂，口服能达到远端回肠和结肠，在此定位释放而发挥作用，因此是治疗轻、中型克罗恩病（病变累及回肠和结肠）的首选药物，由于美沙拉嗪价格昂贵，不作为治疗轻、中型溃疡性结肠炎的首选药物。布地奈德属于新型的糖皮质激素，硫唑嘌呤属于免疫抑制剂.均不是治疗轻、中型溃疡性结肠炎和轻、中型克罗恩病（病变累及回肠和结肠）的首选药物。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"470","all_num":"555","types":0,"pname":"内科学"},{"id":"3870","name":"治疗轻、中型克罗恩病（病变累及回肠和结肠）的首选药物是","data":{"A":"柳氮磺吡啶","B":"美沙拉嗪","C":"布地奈德","D":"硫唑嘌呤"},"da_an":"B","typeid":"117","time":"2018-09-13 15:23:56","xiang_jie":"[考点]炎症性肠病（溃疡性结肠炎和克罗恩病）的治疗                                                          [考点还原]（P392）\u201c（一）控制炎症反应  1.活动期 （1）5-ASA：SASP仅适用于病变局限在结肠的轻度患者（A错）；美沙拉嗪能在回肠末端、结肠定位释放，适用于轻度回结肠型及轻度结肠型患者（B对）\u201d。\r\n[解析]溃疡性结肠炎和克罗恩病均属于炎症性肠病。溃疡性结肠炎是一种病因尚不十分清楚的直肠和结肠慢性非特异性炎症性疾病，治疗轻、中型溃疡性结肠炎的首选药物是柳氮磺吡啶，柳氮磺吡啶口服后，经肠菌分解为5-氨基水杨酸（5-ASA）发挥作用，也可用于重型经糖皮质激素治疗已有缓解者。克罗恩病是一种病因尚不十分清楚的肠道慢性炎性肉芽肿性疾病，病变多见于远端回肠和结肠，美沙拉嗪是5-ASA的新型制剂，口服能达到远端回肠和结肠，在此定位释放而发挥作用，因此是治疗轻、中型克罗恩病（病变累及回肠和结肠）的首选药物，由于美沙拉嗪价格昂贵，不作为治疗轻、中型溃疡性结肠炎的首选药物。布地奈德属于新型的糖皮质激素，硫唑嘌呤属于免疫抑制剂.均不是治疗轻、中型溃疡性结肠炎和轻、中型克罗恩病（病变累及回肠和结肠）的首选药物。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"407","all_num":"575","types":0,"pname":"内科学"},{"id":"3875","name":"自身免疫性胃炎的胃酸分泌","data":{"A":"缺乏","B":"正常或减少","C":"少量增加","D":"明显增加"},"da_an":"A","typeid":"117","time":"2018-09-13 15:24:54","xiang_jie":"[考点]慢性萎缩性胃炎的胃酸分泌情况\r\n[考点还原]（P365）\u201c当体内出现针对壁细胞或内因子的自身抗体时，作为靶细胞的壁细胞总数减少，胃酸分泌降低\u201d（A对）。                                                                                        \r\n[解析]慢性萎缩性胃炎包括自身免疫性胃炎和多灶萎缩性胃炎两大类，自身免疫性胃炎又称胃体胃炎（A塑胃炎），萎缩改变主要位于胃体部，当胃体黏膜出现明显萎缩时，胃液分析显示胃酸分泌缺乏；多灶萎缩性胃炎又称胃窦胃炎（B型胃炎），胃液分析显示胃酸分泌正常或减少；胃酸分泌增加见于十二指肠溃疡和胃泌素瘤。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"394","all_num":"554","types":0,"pname":"内科学"},{"id":"3880","name":"多灶萎缩性胃炎的胃酸分泌","data":{"A":"缺乏","B":"正常或减少","C":"少量增加","D":"明显增加"},"da_an":"B","typeid":"117","time":"2018-09-13 15:25:32","xiang_jie":"[考点]慢性萎缩性胃炎的胃酸分泌情况                                                                                     \r\n[考点还原]  八版内科学未明确说明。\r\n[解析]慢性萎缩性胃炎包括自身免疫性胃炎和多灶萎缩性胃炎两大类，自身免疫性胃炎又称胃体胃炎（A塑胃炎），萎缩改变主要位于胃体部，当胃体黏膜出现明显萎缩时，胃液分析显示胃酸分泌缺乏；多灶萎缩性胃炎又称胃窦胃炎（B型胃炎），胃液分析显示胃酸分泌正常或减少；胃酸分泌增加见于十二指肠溃疡和胃泌素瘤。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"470","all_num":"538","types":0,"pname":"内科学"},{"id":"3883","name":"重度胃体萎缩型胃炎","data":{"A":"胃液酸度升高","B":"胃液酸度正常或减少","C":"胃液酸度常减少","D":"胃液酸度明显升高","E":"胃液酸度明显减少"},"da_an":"E","typeid":"117","time":"2018-09-13 15:26:24","xiang_jie":"[考点]胃肠疾病与胃液酸度改变\r\n[考点还原]  八版内科学未明确说明。                                                                                    \r\n[解析]胃酸是由胃体壁细胞分泌的，当重度胃体萎缩型胃炎时产生胃酸的壁细胞明敁抑制，故胃液酸度应明显减少；而壁细胞上有胃泌素受体，故当胃泌素瘤时，会因分泌大量胃泌素刺激胃壁细胞产生大量胃酸，结果使胃液酸度明显升高。其他几项中，胃液酸度升高见于十二指肠溃疡；胃液酸度正常或减少见于胃溃疡；重度胃窦萎缩型胃炎的胃液酸度常减少。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"362","all_num":"557","types":0,"pname":"内科学"},{"id":"3891","name":"胃泌素瘤：","data":{"A":"胃液酸度升高","B":"胃液酸度正常或减少","C":"胃液酸度常减少","D":"胃液酸度明显升高","E":"胃液酸度明显减少"},"da_an":"D","typeid":"117","time":"2018-09-13 15:26:56","xiang_jie":"[考点]胃肠疾病与胃液酸度改变                                                                                                 \r\n [考点还原]（P372）\u201c（三）Zollinger-Ellison 综合征\u2026该综合征由促胃液素瘤或促胃液素细胞增生所致，临床以高胃酸分泌，血促胃液素水平升高，多发、顽固及不典型部位消化性溃疡及腹泻为特征\u201d（七版内科学P391）\u201c（二）胃泌素瘤  亦称Zollinger-Ellison 综合征，是胰腺非β细胞瘤分泌大量胃泌素所致。肿瘤往往很小（＜1cm），生长缓慢，半数为恶性。大量胃泌素可刺激壁细胞增生，分泌大量胃酸\u201d（D对）。\r\n[解析]胃酸是由胃体壁细胞分泌的，当重度胃体萎缩型胃炎时产生胃酸的壁细胞明敁抑制，故胃液酸度应明显减少；而壁细胞上有胃泌素受体，故当胃泌素瘤时，会因分泌大量胃泌素刺激胃壁细胞产生大量胃酸，结果使胃液酸度明显升高。其他几项中，胃液酸度升高见于十二指肠溃疡；胃液酸度正常或减少见于胃溃疡；重度胃窦萎缩型胃炎的胃液酸度常减少。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"408","all_num":"532","types":0,"pname":"内科学"},{"id":"3896","name":"胃溃疡穿孔","data":{"A":"右上腹绞痛，伴压痛、黄疸，Murphy征阳性","B":"脐周围阵痛，伴有压痛、肠鸣音亢进，有肠型","C":"上腹压痛，板样强直，肝浊音界消失","D":"上腹部胀痛，伴有胃型及拍水声","E":"胸骨下持续性钝痛，腹部体征正常"},"da_an":"C","typeid":"117","time":"2018-09-13 15:27:46","xiang_jie":"[考点]不同胃肠疾病腹痛特点\r\n[考点还原]（P355）\u201c病人突发上腹部剧痛，呈\u2018刀割样\u2019，腹痛迅速波及全腹\u2026体检见病人表情痛苦，取屈曲体位，不敢移动。腹式呼吸减弱或消失，全腹压痛，但以穿孔处最重。腹肌紧张呈\u2018板状腹\u2019，反跳痛明显。肠鸣音减弱或消失。叩诊肝浊音界缩小或消失，可闻移动性浊音\u201d（C对）。                                                                                                                           \r\n[解析]胃溃疡穿孔时可致急性腹膜炎，并有气体进入腹腔，故表现为上腹压痛，板样强直，肝浊音界消失；急性肠梗阻时则因肠道与外界不通，肠内压增高，引起脐周围阵痛，伴有压痛，肠鸣音亢进，有肠型。其他几项中，右上腹绞痛，伴压痛、黄疸、Murphy征阳性显然是胆石症及急性胆囊炎；上腹部胀痛伴有胃型及拍水声见于幽门梗阻；胸骨下持续性钝痛，腹部体征正常见于急性心肌梗死。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"469","all_num":"515","types":0,"pname":"内科学"},{"id":"3901","name":"急性肠梗阻","data":{"A":"右上腹绞痛，伴压痛、黄疸，Murphy征阳性","B":"脐周围阵痛，伴有压痛、肠鸣音亢进，有肠型","C":"上腹部胀痛，伴有胃型及拍水声","D":"胸骨下持续性钝痛，腹部体征正常"},"da_an":"B","typeid":"117","time":"2018-09-13 15:28:26","xiang_jie":"[考点]不同胃肠疾病腹痛特点                                                                                                     \r\n[考点还原]（P375）\u201c腹部视诊：机械性肠梗阻常可见肠型和蠕动波。肠扭转时腹胀多不对称；麻痹性肠梗阻\u2026肠鸣音亢进，有气过水声或金属音，为机械性肠梗阻表现。麻痹性肠梗阻时，则肠鸣音减弱或消失\u201d（B对）。\r\n[解析]胃溃疡穿孔时可致急性腹膜炎，并有气体进入腹腔，故表现为上腹压痛，板样强直，肝浊音界消失；急性肠梗阻时则因肠道与外界不通，肠内压增高，引起脐周围阵痛，伴有压痛，肠鸣音亢进，有肠型。其他几项中，右上腹绞痛，伴压痛、黄疸、Murphy征阳性显然是胆石症及急性胆囊炎；上腹部胀痛伴有胃型及拍水声见于幽门梗阻；胸骨下持续性钝痛，腹部体征正常见于急性心肌梗死。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"439","all_num":"522","types":0,"pname":"内科学"},{"id":"3905","name":"酸泵抑制剂：","data":{"A":"丙谷胺","B":"前列腺素E2的衍生物","C":"奥美拉唑（Omeprazole）","D":"派吡氮平","E":"吗丁啉（多潘立酮）"},"da_an":"C","typeid":"117","time":"2018-09-13 15:29:23","xiang_jie":"[考点]消化性溃疡的治疗\r\n[考点还原]（P373）\u201c表4-5-4  常用的各种PPI\u201d（C对ABDE错）。                                         \r\n[解析]奥美拉唑（Omeprazole）能抑制H+/K＋-ATP酶的活力，因而是酸泵抑制剂；前列腺素E2的衍生物可加强黏膜对损伤的抵抗力，因而是黏膜细胞保护剂。而丙谷胺是抗胃泌素药；派吡氮平是抗胆碱能药；吗丁啉（多潘立酮）是胃动力药。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"489","all_num":"499","types":0,"pname":"内科学"},{"id":"3908","name":"黏膜细胞保护剂","data":{"A":"丙谷胺","B":"前列腺素E2的衍生物","C":"奥美拉唑（Omeprazole）","D":"派吡氮平","E":"吗丁啉（多潘立酮）"},"da_an":"B","typeid":"117","time":"2018-09-13 15:30:22","xiang_jie":"[考点]消化性溃疡的治疗                                                                                                            \r\n[考点还原]（七版内科学P392）\u201c表4-5-1\u201d。（七版内科学P393）\u201c2、保护胃黏膜药物\u2026米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用\u201d（B对）。\r\n[解析]奥美拉唑（Omeprazole）能抑制H+/K＋-ATP酶的活力，因而是酸泵抑制剂；前列腺素E2的衍生物可加强黏膜对损伤的抵抗力，因而是黏膜细胞保护剂。而丙谷胺是抗胃泌素药；派吡氮平是抗胆碱能药；吗丁啉（多潘立酮）是胃动力药。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"484","all_num":"511","types":0,"pname":"内科学"},{"id":"3911","name":"胃泌素产生于：","data":{"A":"壁细胞","B":"主细胞","C":"黏液细胞","D":"G细胞","E":"肥大细胞"},"da_an":"D","typeid":"117","time":"2018-09-13 15:30:56","xiang_jie":"[考点]消化性溃疡的发病机制\r\n[考点还原]（P199）\u201c促胃液素是由胃窦及十二指肠和空肠上段黏膜中G细胞分泌的一种胃肠激素\u201d                                                                                                                                         [解析]胃泌素是由G细胞产生的；胃蛋白酶原是由主细胞产生的。其他细胞分别产生其他物质：如壁细胞产生胃酸和内因子；黏液细胞产生碱性黏液；肥大细胞产生组胺。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"397","all_num":"537","types":0,"pname":"内科学"},{"id":"3913","name":"胃蛋白酶原产生于","data":{"A":"壁细胞","B":"主细胞","C":"黏液细胞","D":"G细胞","E":"肥大细胞"},"da_an":"B","typeid":"117","time":"2018-09-13 15:31:42","xiang_jie":"[考点]消化性溃疡的发病机制                                                                                                     \r\n[考点还原]（P196）\u201c胃蛋白酶原主要由胃泌酸腺的主细胞（B对）合成和分泌。颈黏液细胞、贲门腺和幽门腺的黏液细胞（C对）以及十二指肠近端的腺体也能分泌胃蛋白酶原\u201d。\r\n[解析]胃泌素是由G细胞产生的；胃蛋白酶原是由主细胞产生的。其他细胞分别产生其他物质：如壁细胞产生胃酸和内因子；黏液细胞产生碱性黏液；肥大细胞产生组胺。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"448","all_num":"563","types":0,"pname":"内科学"},{"id":"3916","name":"解除有机磷中毒时烟碱样毒性作用，首选","data":{"A":"阿托品","B":"解磷定","C":"美解眠（贝美格）","D":"尼可刹米","E":"甘露醇"},"da_an":"B","typeid":"117","time":"2018-09-13 15:33:53","xiang_jie":"[考点]有机磷中毒的治疗\r\n[考点还原]（P886）\u201c2.ChE复能药\u2026ChE复能药尚能作用于外周N\u2082受体，对抗外周N胆碱受体活性，能有效解除烟碱样毒性作用，对M样症状和中枢性呼吸抑制作用无明显影响。所用药物如下：（1）氯解磷定（B对）\u201d。（P888）\u201c（1）M胆碱受体阻断药：又称外周性抗胆碱能药。阿托品（A错）和山莨菪碱等主要作用于外周M受体，能缓解M样症状，对N受体无明显作用\u201d。[解析]有机磷中毒时，烟碱样毒性作用是由于胆碱酯酶失活后乙酰胆碱过度蓄积和刺激所致，解磷定是胆碱酯酶复能剂，可恢复胆碱酯酶活力，从而分解乙酰胆碱而发挥治疗作用；阿托品可阻断副交感神经的毒蕈碱样作用，而对烟碱样作用无效。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"389","all_num":"530","types":0,"pname":"内科学"},{"id":"3919","name":"解除有机磷中毒时毒蕈碱样毒性作用，首选","data":{"A":"阿托品","B":"解磷定","C":"美解眠（贝美格","D":"尼可刹米","E":"甘露醇"},"da_an":"A","typeid":"117","time":"2018-09-13 15:34:37","xiang_jie":"[考点]有机磷中毒的治疗                                                                                                            \r\n[考点还原]（P886）\u201c2.ChE复能药\u2026ChE复能药尚能作用于外周N\u2082受体，对抗外周N胆碱受体活性，能有效解除烟碱样毒性作用，对M样症状和中枢性呼吸抑制作用无明显影响。所用药物如下：（1）氯解磷定（B错）\u201d。（P888）\u201c（1）M胆碱受体阻断药：又称外周性抗胆碱能药。阿托品（A对）和山莨菪碱等主要作用于外周M受体，能缓解M样症状，对N受体无明显作用\u201d。\r\n[解析]有机磷中毒时，烟碱样毒性作用是由于胆碱酯酶失活后乙酰胆碱过度蓄积和刺激所致，解磷定是胆碱酯酶复能剂，可恢复胆碱酯酶活力，从而分解乙酰胆碱而发挥治疗作用；阿托品可阻断副交感神经的毒蕈碱样作用，而对烟碱样作用无效。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"424","all_num":"495","types":0,"pname":"内科学"},{"id":"3924","name":"吗丁啉（多潘立酮）","data":{"A":"促进胃排空，增强胃窦和十二指肠运动","B":"减少胃酸和胃蛋白酶分泌","C":"促进胃黏膜血流，刺激胃黏液分泌","D":"防止氢离子反渗，促进胃黏液分泌","E":"减少胃酸分泌，延缓胃排空"},"da_an":"A","typeid":"117","time":"2018-09-13 15:35:14","xiang_jie":"[考点]胃炎和消化性溃疡的治疗\r\n[考点还原]（P359）\u201c促胃肠动力药  如多潘立酮\u201d（A对）。                                                  \r\n[解析]吗丁啉（多潘立酮）是一种胃动力药，因而可促进胃排空及增强胃窦和十二指肠运动；生胃酮（甘珀酸）是自甘草中提取的甘草酸经水解衍化而来，能防止氢离子反渗和促进胃黏液分泌。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"503","all_num":"533","types":0,"pname":"内科学"},{"id":"3929","name":"生胃酮（甘珀酸）","data":{"A":"促进胃排空，增强胃窦和十二指肠运动","B":"减少胃酸和胃蛋白酶分泌","C":"促进胃黏膜血流，刺激胃黏液分泌","D":"防止氢离子反渗，促进胃黏液分泌","E":"减少胃酸分泌，延缓胃排空"},"da_an":"D","typeid":"117","time":"2018-09-13 15:35:58","xiang_jie":"[考点]胃炎和消化性溃疡的治疗                                                                                                 \r\n[考点还原]  八版内科学未明确说明。\r\n[解析]吗丁啉（多潘立酮）是一种胃动力药，因而可促进胃排空及增强胃窦和十二指肠运动；生胃酮（甘珀酸）是自甘草中提取的甘草酸经水解衍化而来，能防止氢离子反渗和促进胃黏液分泌。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"275","all_num":"553","types":0,"pname":"内科学"},{"id":"3933","name":"B胃炎伴大量G细胞丧失","data":{"A":"胃酸度升高","B":"胃酸度正常或减少","C":"胃酸度常减少","D":"胃酸度明显升高","E":"胃酸度明显减少"},"da_an":"C","typeid":"117","time":"2018-10-11 19:33:40","xiang_jie":"[考点]胃炎和消化性溃疡的胃液分析\r\n \r\n[考点还原]  八版内科学未明确说明。                                                                                    \r\n [解析]B型胃炎不影响胃酸分泌，但有大量G细胞丧失时则胃酸度常减少；胃溃疡的胃酸分泌在正常范围内，亦可减少。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"263","all_num":"594","types":0,"pname":"内科学"},{"id":"3937","name":"胃溃疡","data":{"A":"胃酸度升高","B":"胃酸度正常或减少","C":"胃酸度常减少","D":"胃酸度明显升高","E":"胃酸度明显减少"},"da_an":"B","typeid":"117","time":"2018-09-13 15:37:12","xiang_jie":"[考点]胃炎和消化性溃疡的胃液分析                                                                                         \r\n[考点还原]（七版内科学P388）\u201cGU患者基础酸排量（BAO）及MAO多属正常或偏低，对此，可能解释为GU患者多伴多灶萎缩性胃炎，因为胃体壁细胞泌酸功能已受影响\u201d（B对）。\r\n[解析]B型胃炎不影响胃酸分泌，但有大量G细胞丧失时则胃酸度常减少；胃溃疡的胃酸分泌在正常范围内，亦可减少。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"390","all_num":"561","types":0,"pname":"内科学"},{"id":"3943","name":"引起胰腺细胞坏死的是","data":{"A":"胰蛋白酶","B":"糜蛋白酶","C":"弹力蛋白酶","D":"磷脂酶A","E":"激肽酶"},"da_an":"D","typeid":"117","time":"2018-09-13 15:37:53","xiang_jie":"[考点]急性胰腺炎的发病机制\r\n[考点还原]（七版内科学P470）\u201c磷脂酶A\u2082在小量胆酸参与下分解细胞膜的磷脂（D对），产生溶血磷脂酰胆碱和溶血脑磷脂，其细胞毒作用引起胰实质凝固性坏死、脂肪组织坏死及溶血\u201d。                                                                                                                                         \r\n [解析]这是两道记忆题，引起胰腺细胞坏死的是磷脂酶A；引起胰腺血管坏死的是弹力蛋白酶。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"340","all_num":"563","types":0,"pname":"内科学"},{"id":"3947","name":"引起胰腺血管坏死的是：","data":{"A":"胰蛋白酶","B":"糜蛋白酶","C":"弹力蛋白酶","D":"磷脂酶A","E":"激肽酶"},"da_an":"C","typeid":"117","time":"2018-09-13 15:38:36","xiang_jie":"[考点]急性胰腺炎的发病机制                                                                                                     \r\n[考点还原]（七版内科学P470）\u201c弹性蛋白酶可溶解血管弹性纤维引起出血和血栓形成\u201d（C对）。\r\n[解析]这是两道记忆题，引起胰腺细胞坏死的是磷脂酶A；引起胰腺血管坏死的是弹力蛋白酶。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"502","all_num":"560","types":0,"pname":"内科学"},{"id":"3953","name":"胆红素生成过多见于","data":{"A":"Gilbert综合征","B":"无效造血","C":"Dubin-Johnson综合征","D":"Crigler-Najjar综合征","E":"Rotor综合征"},"da_an":"B","typeid":"117","time":"2018-09-13 15:39:16","xiang_jie":"[考点]黄疸的发生机制\r\n[考点还原]（八版诊断学P38）\u201cGlbert综合征Dubin-Johnson综合征（A错）：系由肝细胞摄取UCB功能障碍及微粒体内葡萄糖醛酸转移酶不足，致血中UCB增高而出现黄疸\u201d。（八版诊断学P38）\u201cDubin-Johnson综合征（C错）：系由肝细胞对CB及某些阴离子向毛细胆管排泄发生障碍，致血清CB增加而发生的黄疸\u201d。 （八版诊断学P38-P39） \u201cCrigler-najjar综合征（D错）：系由肝细胞缺乏葡萄糖醛酸转移酶，致UCB不能形成CB，导致血中UCB增多而出现黄疸\u201d。（八版诊断学P39）\u201cRotor综合征（E错）：系由肝细胞对摄取UCB和排泄CB存在先天性缺陷致血中胆红素增高而出现黄疸\u201d。                                                                   \r\n[解析]无效造血是骨髓内的原位溶血，由于溶血则可使胆红素生成过多；Dubin-Johnson综合征是肝细胞向毛细胆管排泄结合胆红素障碍，而胆红素的摄取和结合正常：Gilbert综合征是因肝细胞摄取游离胆红素障碍及微粒体内葡萄糖醛酸转移酶不足所致；Grigler-Najjar综合征是由于肝细胞缺乏葡萄糖醛酸转移酶，致不能形成结合胆红素，使血中非结合胆红素浓度增高；Rotor综合征是肝细胞摄取游离胆红素和排泄结合胆红素均有先天性缺陷，致血中结合胆红素增高为主。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"220","all_num":"532","types":0,"pname":"内科学"},{"id":"3961","name":"肝细胞向毛细胆管排泄结合胆红素障碍，而胆红素的摄取和结合正常见于","data":{"A":"Gilbert综合征","B":"无效造血","C":"Dubin-Johnson综合征","D":"Crigler-Najjar综合征","E":"Rotor综合征"},"da_an":"C","typeid":"117","time":"2018-09-13 15:39:56","xiang_jie":"[考点]黄疸的发生机制                                                                                                            \r\n[考点还原]（八版诊断学P38）\u201cGlbert综合征（A错）：系由肝细胞摄取UCB功能障碍及微粒体内葡萄糖醛酸转移酶不足，致血中UCB增高而出现黄疸\u201d。（八版诊断学P38）\u201cDubin-Johnson综合征（C对）：系由肝细胞对CB及某些阴离子向毛细胆管排泄发生障碍，致血清CB增加而发生的黄疸\u201d。（八版诊断学P38-P39P38）\u201cGlbert综合征（A错）：系由肝细胞摄取UCB功能障碍及微粒体内葡萄糖醛酸转移酶不足，致血中UCB增高而出现黄疸\u201d。（八版诊断学P38）\u201cDubin-Johnson综合征（C对）：系由肝细胞对CB及某些阴离子向毛细胆管排泄发生障碍，致血清CB增加而发生的黄疸\u201d。（八版诊断学P38-P39）\u201cCrigler-najjar综合征（D错）：系由肝细胞缺乏葡萄糖醛酸转移酶，致UCB不能形成CB，导致血中UCB增多而出现黄疸\u201d。（八版诊断学P39）\u201cRotor综合征（E错）：系由肝细胞对摄取UCB和排泄CB存在先天性缺陷致血中胆红素增高而出现黄疸\u201d。\r\n[解析]无效造血是骨髓内的原位溶血，由于溶血则可使胆红素生成过多；Dubin-Johnson综合征是肝细胞向毛细胆管排泄结合胆红素障碍，而胆红素的摄取和结合正常：Gilbert综合征是因肝细胞摄取游离胆红素障碍及微粒体内葡萄糖醛酸转移酶不足所致；Grigler-Najjar综合征是由于肝细胞缺乏葡萄糖醛酸转移酶，致不能形成结合胆红素，使血中非结合胆红素浓度增高；Rotor综合征是肝细胞摄取游离胆红素和排泄结合胆红素均有先天性缺陷，致血中结合胆红素增高为主。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"365","all_num":"492","types":0,"pname":"内科学"},{"id":"3964","name":"阿片类麻醉药的解毒药是：","data":{"A":"依地酸二钠钙","B":"亚甲蓝","C":"二巯基丁二酸","D":"氟马西尼","E":"纳洛酮"},"da_an":"E","typeid":"117","time":"2018-09-13 15:40:49","xiang_jie":"[考点]中毒的特殊解毒药治疗\r\n[考点还原]（P882）\u201c1）纳洛酮：是阿片类麻醉药的解毒药，对麻醉镇痛药引起的呼吸抑制有特异性拮抗作用\u201d（E对）。                                                                                                    \r\n[解析]这是关于中毒时特殊解毒药的应用问题，纳洛酮是阿片类麻醉药的解毒药，对麻醉镇痛药引起的呼吸抑制有特异的拮抗作用；亚硝酸盐中毒时引起高铁血红蛋白血症，亚甲蓝可使高铁血红蛋白还原为正常血红蛋白。而依地酸二钠钙和二巯基丁二酸是金属中毒的解毒剂；氟马西尼是苯二氮䓬类中毒的拮抗剂。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"431","all_num":"483","types":0,"pname":"内科学"},{"id":"3969","name":"亚硝酸盐中毒的解毒药是","data":{"A":"依地酸二钠钙","B":"亚甲蓝","C":"二巯基丁二酸","D":"氟马西尼","E":"纳洛酮"},"da_an":"B","typeid":"117","time":"2018-09-13 15:41:22","xiang_jie":"[考点]中毒的特殊解毒药治疗                                                                                                     [考点还原]（P881）\u201c（2）高铁血红蛋白血症解毒药：亚甲蓝（美蓝）（B对）：小剂量亚甲蓝可使高铁血红蛋白还原为正常血红蛋白，用于治疗亚硝酸盐、苯胺或硝基苯等中毒引起的高铁血红蛋白血症\u201d。\r\n[解析]这是关于中毒时特殊解毒药的应用问题，纳洛酮是阿片类麻醉药的解毒药，对麻醉镇痛药引起的呼吸抑制有特异的拮抗作用；亚硝酸盐中毒时引起高铁血红蛋白血症，亚甲蓝可使高铁血红蛋白还原为正常血红蛋白。而依地酸二钠钙和二巯基丁二酸是金属中毒的解毒剂；氟马西尼是苯二氮䓬类中毒的拮抗剂。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"411","all_num":"496","types":0,"pname":"内科学"},{"id":"3972","name":"血液灌流可清除的脂溶化合物是","data":{"A":"短效巴比妥类","B":"苯巴比妥","C":"水杨酸类","D":"甲醇","E":"锂"},"da_an":"A","typeid":"117","time":"2018-09-13 15:41:47","xiang_jie":"[考点]中毒的治疗\r\n[考点还原]（P880）\u201c2）血液灌流\u2026此法能吸附脂溶性或与蛋白质结合的化学物，能清除血液中巴比妥类（短效（A对）、长效（B对））和百草枯等，是目前最常用的中毒抢救措施\u201d。（P880）\u201c1）血液透析：用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥、水杨酸类（C错）、甲醇（D错）、茶碱、乙二醇和锂（E错）等）\u201d                             \r\n[解析]短效巴比妥类是脂溶性化学物质，所以透析效果不好，而血液灌流能吸附脂溶性或与蛋白质结合的化学物质，所以可以清除。其余各项都非脂溶性，所以两题的答案都是A。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"293","all_num":"520","types":0,"pname":"内科学"},{"id":"3975","name":"透析疗法不能很好清除的是","data":{"A":"短效巴比妥类","B":"苯巴比妥","C":"水杨酸类","D":"甲醇","E":"锂"},"da_an":"A","typeid":"117","time":"2018-09-13 15:42:24","xiang_jie":"[考点]中毒的治疗                                                                                                                        \r\n [考点还原]（P880）\u201c1）血液透析：用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥（B错）、水杨酸类（C错）、甲醇（D错）、茶碱、乙二醇和锂（E错）等）。短效巴比妥类（A对）、格鲁米特（导眠能）和OPI因具有脂溶性，一般不进行血液透析\u201d。\r\n[解析]短效巴比妥类是脂溶性化学物质，所以透析效果不好，而血液灌流能吸附脂溶性或与蛋白质结合的化学物质，所以可以清除。其余各项都非脂溶性，所以两题的答案都是A。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"340","all_num":"544","types":0,"pname":"内科学"},{"id":"3977","name":"有机磷（对硫磷）农药中毒的洗胃液是","data":{"A":"1:5000高锰酸钾","B":"2%碳酸氢钠","C":"0.3%H2O2","D":"0.3%氧化镁","E":"5%硫酸钠"},"da_an":"B","typeid":"117","time":"2018-09-13 15:43:09","xiang_jie":"[考点]中毒的洗胃治疗\r\n[考点还原]（P879-P880）\u201c表9-2-4  洗胃液配制和应用注意要点\u201d（B对ACDE错）。（P886）\u201c（一）迅速清除毒物\u2026口服中毒者，用清水、2％碳酸氢钠溶液（敌百虫中毒者忌用）（B对）或1：5000高锰酸钾溶液（对硫磷中毒者忌用）（A错）反复洗胃\u201d。             \r\n[解析]中毒洗胃时所用的洗胃液应依毒物的种类不同而异，一般有机磷农药中毒的洗胃液可用1:5000高锰酸钾或2%碳酸氢钠，但对硫磷中毒时若用前者，会使其氧化为毒性更强的对氧磷，因此只能用后者；镇静药中毒的洗胃液是1:5000高锰酸钾，可有氧化解毒作用。而0.3%H2O2常用于阿片类等中毒，0.3%氧化镁作为中和剂用于阿司匹林、草酸中毒，5%硫酸钠作为沉淀剂用于氯化钡和碳酸钡中毒。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"324","all_num":"516","types":0,"pname":"内科学"},{"id":"3979","name":"镇静药物中毒的洗胃液是","data":{"A":"1:5000高锰酸钾","B":"2%碳酸氢钠","C":"0.3%H2O2","D":"0.3%氧化镁","E":"5%硫酸钠"},"da_an":"A","typeid":"117","time":"2018-09-13 15:43:55","xiang_jie":"[考点]中毒的洗胃治疗                                                                                                                \r\n[考点还原]（P879）\u201c表9-2-4  洗胃液配制和应用注意要点\u201d（A对）。\r\n[解析]中毒洗胃时所用的洗胃液应依毒物的种类不同而异，一般有机磷农药中毒的洗胃液可用1:5000高锰酸钾或2%碳酸氢钠，但对硫磷中毒时若用前者，会使其氧化为毒性更强的对氧磷，因此只能用后者；镇静药中毒的洗胃液是1:5000高锰酸钾，可有氧化解毒作用。而0.3%H2O2常用于阿片类等中毒，0.3%氧化镁作为中和剂用于阿司匹林、草酸中毒，5%硫酸钠作为沉淀剂用于氯化钡和碳酸钡中毒。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"358","all_num":"473","types":0,"pname":"内科学"},{"id":"3982","name":"最易并发原发性肝癌的是","data":{"A":"病毒性肝炎后肝硬化","B":"酒精性肝硬化","C":"原发性胆汁性肝硬化","D":"淤血性肝硬化","E":"血吸虫病性肝纤维化"},"da_an":"A","typeid":"117","time":"2018-09-13 15:44:23","xiang_jie":"[考点]肝硬化的实验室检查和并发症\r\n[考点还原]（P429）\u201c在我国，肝癌患者中约90％有乙型肝炎病毒感染的背景\u201d（A对）。  \r\n[解析]原发性肝癌合并肝硬化者占50%〜90%,病理检查发现多为病毒性（乙型或丙型病毒性肝炎）肝硬化，而欧美国家肝癌常发生在酒精性肝硬化的基础上，一般认为其余三种肝硬化与原发性肝癌的发生无关；原发性胆汁性肝硬化的80%以上患者血清抗线粒体抗体阳性，而且滴度很高，其他类型肝硬化不会如此，借此化验还可与其他胆汁淤积性黄疸鉴别。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"485","all_num":"496","types":0,"pname":"内科学"},{"id":"3984","name":"血清抗线粒体抗体阳性率高且滴度高的是","data":{"A":"病毒性肝炎后肝硬化","B":"酒精性肝硬化","C":"原发性胆汁性肝硬化","D":"淤血性肝硬化","E":"血吸虫病性肝纤维化"},"da_an":"C","typeid":"117","time":"2018-09-13 15:45:00","xiang_jie":"[考点]肝硬化的实验室检查和并发症                                                                                         \r\n[考点还原]（P414）\u201c（三）免疫学检查  95％以上患者AMA（血清抗线粒体抗体）阳性，滴度＞1：40有诊断意义，AMA的特异性可达98％\u201d（C对）。\r\n[解析]原发性肝癌合并肝硬化者占50%〜90%,病理检查发现多为病毒性（乙型或丙型病毒性肝炎）肝硬化，而欧美国家肝癌常发生在酒精性肝硬化的基础上，一般认为其余三种肝硬化与原发性肝癌的发生无关；原发性胆汁性肝硬化的80%以上患者血清抗线粒体抗体阳性，而且滴度很高，其他类型肝硬化不会如此，借此化验还可与其他胆汁淤积性黄疸鉴别。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"395","all_num":"564","types":0,"pname":"内科学"},{"id":"3988","name":"血液透析治疗急性中毒的首选指征是","data":{"A":"生物毒类中毒","B":"乙二醇中毒","C":"氯酸盐中毒","D":"导眠能（格鲁米特）中毒","E":"短效巴比妥类中毒"},"da_an":"C","typeid":"117","time":"2018-09-13 15:45:38","xiang_jie":"[考点]中毒的血液净化治疗\r\n[考点还原]（P880）\u201c1）血液透析\u2026氯酸盐（C对）或重铬酸盐中毒能引起急性肾衰竭，首选血液透析\u201d。                                                                                                                             \r\n[解析]血液透析可适用于清除血液中分子量较小、非脂溶性的毒物，氯酸盐和重铬酸盐能损害肾引起急性肾衰竭，因此是血液透析的首选指征，而短效巴比妥类、导眠能（格鲁米特）和有机磷杀虫药因具有脂溶性，透析效果不好。血浆置换无论是对溶液或与蛋白结合的毒物，特别是生物毒如蛇毒、蕈中毒及砷化氢等溶血毒物中毒，疗效更佳。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"208","all_num":"505","types":0,"pname":"内科学"},{"id":"3993","name":"最适于血浆置换治疗的中毒是：","data":{"A":"生物毒类中毒","B":"乙二醇中毒","C":"氯酸盐中毒","D":"导眠能（格鲁米特）中毒","E":"短效巴比妥类中毒"},"da_an":"A","typeid":"117","time":"2018-09-13 15:46:07","xiang_jie":"[考点]中毒的血液净化治疗                                                                                                         [考点还原]（P881）\u201c3）血浆置换：本疗法用于清除游离或与蛋白质结合的毒物，特别适用于生物毒（如蛇毒、蕈中毒）（A对）及砷化氢等溶血毒物中毒。一般需在数小时内置换3～5L血浆\u201d。\r\n[解析]血液透析可适用于清除血液中分子量较小、非脂溶性的毒物，氯酸盐和重铬酸盐能损害肾引起急性肾衰竭，因此是血液透析的首选指征，而短效巴比妥类、导眠能（格鲁米特）和有机磷杀虫药因具有脂溶性，透析效果不好。血浆置换无论是对溶液或与蛋白结合的毒物，特别是生物毒如蛇毒、蕈中毒及砷化氢等溶血毒物中毒，疗效更佳。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"318","all_num":"474","types":0,"pname":"内科学"},{"id":"3997","name":"侵入性检查幽门螺杆菌的首选方法是","data":{"A":"胃组织学检查","B":"快速尿素酶试验","C":"幽门螺杆菌培养","D":"14C尿素呼气试验","E":"血清学检查"},"da_an":"B","typeid":"117","time":"2018-09-13 15:46:34","xiang_jie":"[考点]幽门螺杆菌的检查方法\r\n[考点还原]（七版内科学P533）\u201c快速尿素酶试验是侵入性检查的首选方法\u201d（C对）          \r\n [解析]幽门螺杆菌的检查方法有侵入性和非侵入性两类，其中侵入性方法包括快速尿素酶试验、胃组织学检查及细菌培养等，快速尿素酶试验是侵入性检查幽门螺杆菌的首选方法。当幽门螺杆菌根除治疗后复查疗效时，首选的检查方法是l3C尿素呼气试验，这是最常用的非侵入性检查幽门螺杆菌的方法，虽然血清学检查也是非侵入性检查幽门螺杆菌的方法，但由于该方法检查的是抗幽门螺杆菌的抗体，当幽门螺杆菌根除治疗后，幽门螺杆菌可能已被根除，但其抗体却不会随幽门螺杆菌根除而消失；另外当幽门螺杆菌根除治疗后复查疗效时，也不会选用侵入性检查幽门螺杆菌的方法。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"508","all_num":"521","types":0,"pname":"内科学"},{"id":"4001","name":"作为幽门螺杆菌根除治疗后复查的首选方法是","data":{"A":"胃组织学检查","B":"快速尿素酶试验","C":"幽门螺杆菌培养","D":"14C尿素呼气试验","E":"血清学检查"},"da_an":"D","typeid":"117","time":"2018-09-13 15:47:22","xiang_jie":"[考点]幽门螺杆菌的检查方法                                                                                                     \r\n[考点还原]（七版内科学P390）\u201c¹³C或¹\u2074C尿素呼气试验检测幽门螺杆菌敏感性及特异性高而无需胃镜检查，可作为根除治疗后复查的首选方法\u201d（D对）。\r\n[解析]幽门螺杆菌的检查方法分为侵入性和非侵入性两大类，侵入性需通过胃镜取胃黏膜活组织进行检查，主要包括快速尿素酶试验、胃组织学检查和幽门螺杆菌培养，其中快速尿素酶试验是首选方法，因为操作简便，费用低；非侵入性包括13C或14C尿素呼气试验、粪便幽门螺杆菌抗原检测及血清学检查（定性检测血清抗幽门螺杆菌IgG抗体），因为13C或14C尿素呼气试验检测幽门螺杆菌敏感性和特异性高而无需作胃镜，所以作为幽门螺杆菌根除治疗后复查的首选方法。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"514","all_num":"524","types":0,"pname":"内科学"},{"id":"4007","name":"溃疡性结肠炎的并发症可有：","data":{"A":"中毒性巨结肠","B":"癌变","C":"肠出血","D":"肠穿孔"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:48:06","xiang_jie":"[考点]溃疡性结肠炎的并发症\r\n[考点还原]（P387）\u201c【并发症】（一）中毒性巨结肠（A对）\u2026\u2026本并发症易引起急性肠穿孔\u2026\u2026（二）直肠结肠癌变（B对）\u2026\u2026（三）其他并发症结肠大出血（C对）发生率约3%；肠穿孔（D对）多于中毒巨结肠有关\u201d\r\n[解析]溃疡性结肠炎是一种原因不明的直肠和结肠非特异性炎性疾病，临床上多呈反复发作慢性过程。该病的并发症包括中毒性巨结肠、肠穿孔、大量出血、结直肠癌、肠梗阻、瘘管形成和肛门、直肠周围病变等。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"348","all_num":"637","types":0,"pname":"内科学"},{"id":"4009","name":"下列药物中毒时采用血液透析治疗有效的有","data":{"A":"苯巴比妥","B":"茶碱","C":"水杨酸类","D":"有机磷杀虫药"},"da_an":"A@B@C","typeid":"117","time":"2018-09-13 15:48:49","xiang_jie":"[考点]血液透析治疗有效的药物中毒\r\n[考点还原]（P880）\u201c1）血液透析：用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥（A对）、水杨酸类（C对）、甲醇、茶碱（B对）、乙二醇和锂等）。短效巴比妥类、格鲁米特（导眠能）和OPI（D错）因具有脂溶性，一般不进行血液透析\u201d。\r\n[解析]血液透析治疗用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥、茶碱、水杨酸类、甲醇、乙二醇和锂等）。因此答案是ABC。而有机磷杀虫药是脂溶性的，所以血液透析治疗是无效的。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"241","all_num":"549","types":0,"pname":"内科学"},{"id":"4014","name":"根除胃幽门螺杆菌治疗时常用的药物包括","data":{"A":"雷尼替丁","B":"奥美拉唑","C":"硫糖铝","D":"克拉霉素"},"da_an":"B@D","typeid":"117","time":"2018-08-06 12:00:54","xiang_jie":"[考点]胃幽门螺杆菌（Hp）的根除治疗\r\n[考点还原]（P366）\u201c这些抗生素在酸性环境下不能正常发挥其抗菌作用，需要联合PPI抑制胃酸后，才能使其发挥作用。常用的联合方案有：1种PPI+2种抗生素或1种铋剂+2种抗生素，疗程7～14天\u201d（B对）。（P366）\u201c表4-4-1  具有杀灭和抑制Hp作用的药物\u201d（D对）。\r\n[解析]具有杀灭或抑制Hp作用的药物包括：①抗生素：克拉霉素、羟氨苄青霉素、甲硝唑、替硝唑、喹诺酮类抗生素、痢特灵、四环素；②质子泵抑制剂（PPI）：埃索美拉唑、兰索拉唑、奥美拉唑、潘托拉唑、雷贝拉唑等；③铋剂：三钾二枸橼酸铋、果胶铋、次碳酸铋。雷尼替丁和硫糖铝不属于根除胃幽门螺杆菌治疗时常用的药物。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"250","all_num":"627","types":0,"pname":"内科学"},{"id":"4016","name":"对原发性肝癌高危人群进行普查的主要方法有","data":{"A":"血清AFP测定","B":"腹部B超检查","C":"腹部CT检查","D":"肝MRI检查"},"da_an":"A@B","typeid":"117","time":"2018-09-13 15:49:56","xiang_jie":"[考点]原发性肝癌高危人群的普查\r\n[考点还原]（P431）\u201c1.甲胎蛋白（AFP） 是诊断肝细胞癌特异性的标志物，阳性率约为70％。现已广泛用于肝癌的普查、诊断、判断治疗效果及预测复发\u201d（A对）。（P431）\u201c1.超声（US） 是目前肝癌筛查的首选方法\u201d（B对）。\r\n[解析]原发性肝癌是我国常见的恶性肿瘤之一，其死亡率在恶性肿瘤中居第二位，因此对高危人群进行普查是必要的。血清AFP（甲胎蛋白）是诊断原发性肝癌特异性的标志物，阳性率约为70%，因此血清AFP测定现已广泛用于肝癌的普查；腹部B超检查具有方便易行、价格低廉及无创等优点，也是目前肝癌的筛查首选的方法；而腹部CT检查和肝MRI检查的价格均比较高，所以均不适于对原发性肝癌高危人群的普查，只有当血清AFP测定和腹部B超检查高度可疑肝癌时才适用。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"292","all_num":"580","types":0,"pname":"内科学"},{"id":"4020","name":"原发性肝癌发生的伴癌综合征的主要表现有","data":{"A":"自发性低血糖症","B":"高钙血症","C":"高脂血症","D":"红细胞增多症"},"da_an":"A@D","typeid":"117","time":"2018-09-13 15:50:24","xiang_jie":"[考点]原发性肝癌发生的伴癌综合征\r\n[考点还原]（P430）\u201c（六）伴癌综合征\u2026主要表现为自发性低血糖症（A对）、红细胞增多症（D对）；其他罕见的有高钙血症（B错）、高脂血症（C错）、类癌综合征等\u201d。\r\n[解析]伴癌综合征系指原发性肝癌患者由于癌肿本身代谢异常或癌组织对机体影响而引起内分泌或代谢异常的一组症候群，主要表现为自发性低血糖症、红细胞增多症，其他罕见的有高钙血症、高脂血症和类癌综合征等。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"285","all_num":"594","types":0,"pname":"内科学"},{"id":"4035","name":"下列属于慢性胃炎发病原因的有","data":{"A":"Hp感染","B":"自身免疫","C":"精神刺激","D":"十二指肠液反流入胃\t"},"da_an":"A@B@D","typeid":"117","time":"2018-09-13 15:51:06","xiang_jie":"[考点]慢性胃炎的发病原因\r\n[考点还原]（P364）\u201c【病因和发病机制】 （一）Hp感染（A对）\u2026（二）十二指肠-胃反流（D对）\u2026（三）自身免疫（B对）\u2026（四）年龄因素和胃黏膜营养因子缺乏\u201d。\r\n[解析]慢性胃炎是由各种病因引起的胃黏膜慢性炎症，发病原因包括Hp感染、自身免疫、饮食和环境因素及其他因素（如含胆汁和胰液的十二指肠液反流入胃、服用NSAID等药物、某些刺激性食物等）。而精神刺激一般不是慢性胃炎的发病原因。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"219","all_num":"601","types":0,"pname":"内科学"},{"id":"4040","name":"在治疗溃疡性结肠炎的常用药物中，可避免在小肠近段被吸收的氨基水杨酸制剂有","data":{"A":"柳氮磺吡啶","B":"巴柳氮","C":"美沙拉嗪","D":"奥沙拉嗪"},"da_an":"B@C@D","typeid":"117","time":"2018-09-13 15:51:39","xiang_jie":"[考点]溃疡性结肠炎的常用治疗药物\r\n[考点还原]（七版内科学P414）\u201c口服5-ASA新型制剂可避免在小肠近段被吸收，而在结肠内发挥药效，这类制剂有各种控释剂型的美沙拉嗪、奥沙拉嗪、巴柳氮\u201d（BCD对）。\r\n[解析]本题是一道记忆型题，可避免在小肠近段被吸收的氨基水杨酸制剂有巴柳氮、美沙拉嗪、奥沙拉嗪，这是治疗溃疡性结肠炎的新型制剂，优点是不良反应明显减少，但价格昂贵。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"266","all_num":"568","types":0,"pname":"内科学"},{"id":"4045","name":"下列关于急性中毒特殊解毒药的应用，正确的是","data":{"A":"依地酸钙钠治疗铅中毒","B":"二巯丙醇治疗砷中毒","C":"去铁胺治疗镁中毒","D":"亚甲蓝治疗亚硝酸盐中毒\t"},"da_an":"A@B@D","typeid":"117","time":"2018-08-06 12:08:36","xiang_jie":"[考点]急性中毒特殊解毒药的应用\r\n[考点还原]（P881）\u201c表9-2-5  毒物络合剂的应用\u201d（AB对C错）。（P881）\u201c（2）高铁血红蛋白血症解毒药：亚甲蓝（美蓝）：小剂量亚甲蓝可使高铁血红蛋白还原为正常血红蛋白，用于治疗亚硝酸盐、苯胺或硝基苯等中毒引起的高铁血红蛋白血症\u201d（D对）。\r\n[解析]某些急性中毒常有相应的特殊解毒药，临床上应用后会取得非常显著的疗效，如依地酸钙钠治疗铅中毒、二巯丙醇治疗砷中毒、亚甲蓝治疗亚硝酸盐中毒和去铁胺治疗铁中毒等，而去铁胺不是治疗镁中毒。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"241","all_num":"480","types":0,"pname":"内科学"},{"id":"4049","name":"胃食管反流病患者中，由反流物引起的临床表现有","data":{"A":"癔球症","B":"咽喉炎、声嘶","C":"非季节性哮喘","D":"反复发生肺炎"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:52:17","xiang_jie":"[考点]胃食管反流病的临床表现\r\n[考点还原]（P357-P358）\u201c（二）食管外症状  由反流物刺激或损伤食管以外的组织或器官引起，如咽喉炎、慢性咳嗽和哮喘（BC对）\u2026严重者可发生吸入性肺炎（D对）\u2026一些患者诉咽部不适，有异物感或堵塞感，但无吞咽困难，称为癔球症（A对），目前也认为与GERD相关\u201d。\r\n[解析]胃食管反流病患者中，由反流物直接引起食管症状很常见，但反流物刺激或损伤食管外的组织或器官也常引起一些临床表现，易被忽视，本题中的四种临床表现均为反流物刺激或损伤食管外的组织或器官引起的临床表现。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"281","all_num":"564","types":0,"pname":"内科学"},{"id":"4053","name":"下列肝硬化的临床类型中，发现肝肿大的有","data":{"A":"肝炎后肝硬化","B":"淤血性肝硬化","C":"酒精性肝硬化","D":"原发性胆汁性肝硬化\t"},"da_an":"B@C@D","typeid":"117","time":"2018-09-13 15:52:50","xiang_jie":"[考点]肝硬化的临床表现\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]这是一道记忆题，一般肝硬化的肝脏是缩小的，如肝炎后肝硬化等，而淤血性肝硬化、酒精性肝硬化和原发性胆汁性肝硬化患者的肝脏是肿大的。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"287","all_num":"511","types":0,"pname":"内科学"},{"id":"4058","name":"治疗急性有机磷中毒时，出现\u201c阿托品化\u201d的表现有","data":{"A":"瞳孔扩大","B":"颜面潮红","C":"心率减慢","D":"肺部啰音消失"},"da_an":"A@B@D","typeid":"117","time":"2018-08-06 12:10:59","xiang_jie":"[考点]有机磷中毒治疗时的阿托品应用\r\n[考点还原]（P888）\u201c（1）M胆碱受体拮抗药\u2026阿托品化指征为口干、皮肤干燥、心率增快（90～100次/分）（C错）和肺湿啰音消失（D对）\u201d。\r\n[解析]当治疗有机磷中毒时，常应用阿托品以对抗体内过多的乙酰胆碱，当出现\u201c阿托品化\u201d时，说明已达到治疗剂量，\u201c阿托品化\u201d时的表现为瞳孔扩大、颜面潮红、心率增快、肺部啰音消失等，因此答案应选ABD。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"232","all_num":"491","types":0,"pname":"内科学"},{"id":"4060","name":"背部疼痛可发生于","data":{"A":"胰腺癌","B":"球后溃疡","C":"幽门梗阻","D":"穿透性溃疡"},"da_an":"A@B@D","typeid":"117","time":"2018-09-13 15:53:33","xiang_jie":"[考点]消化系统疾病临床表现\r\n[考点还原]（P370）\u201c3.球后溃疡\u2026疼痛可向右上腹及背部放射\u201d（B对）。（P371）\u201c2.溃破穿孔并受阻于毗邻实质性器官，如肝、胰、脾等（穿透性溃疡） 发生较慢，改变了腹痛规律，变得顽固而持续。如穿透至胰腺，腹痛放射至背部，血淀粉酶可升高\u201d（D对）。（P371）\u201c临床症状常有：明显上腹胀痛，餐后加重，呕吐后腹痛可稍缓解，呕吐物可为宿食\u201d（C错）。（P449）\u201c典型腹痛为：持续、进行性加剧的中上腹痛或持续腰背部剧痛，可有阵发性绞痛\u201d（A对）。\r\n[解析]凡病变侵犯到腹腔神经丛者均可引起背部疼痛，胰腺癌在后腹腔，可浸润或压迫腹腔神经丛，因而可引起背痛；球后溃疡一般发生在十二指肠降部的十二指肠乳头近端，常发生于后壁，可影响腹腔神经丛引起背痛；穿透性溃疡发生于后壁时亦同样引起背痛。而幽门梗阻则不会引起背痛。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"263","all_num":"536","types":0,"pname":"内科学"},{"id":"4063","name":"关于萎缩性胃窦胃炎，下列哪几项正确","data":{"A":"可同时伴有胃体黏膜灶性萎缩","B":"可伴有浅表性胃炎","C":"可能与幽门螺杆菌相关","D":"可能与胆汁反流有关\t"},"da_an":"A@B@C@D","typeid":"117","time":"2018-08-06 12:12:37","xiang_jie":"[考点]萎缩性胃窦胃炎\r\n[考点还原]（P364）\u201c（一）Hp感染\u2026（二）十二指肠-胃反流（D对）\u2026（三）自身免疫\u201d。（八版病理学P188-P189）\u201c2.慢性萎缩性胃炎\u2026部分由慢性浅表性胃炎迁延发展而来\u201d（B对）。\r\n[解析]萎缩性胃窦胃炎以胃窦部为主，可同时伴有胃体黏膜灶性萎缩，也可伴有浅表性胃炎。关于萎缩性胃窦胃炎的发病机制尚未完全明了，发现胃窦黏膜层接近上皮细胞表面有大量幽门螺杆菌，因此考虑可能与感染幽门螺杆菌相关，另外发现患者常有幽门括约肌功能失调，引起胆汁反流，因此考虑也可能与胆汁反流有关。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"231","all_num":"548","types":0,"pname":"内科学"},{"id":"4065","name":"胃内幽门螺杆菌阳性常见于","data":{"A":"糜烂性胃炎","B":"活动性胃炎","C":"十二指肠球溃疡","D":"十二指肠球炎"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:54:48","xiang_jie":"[考点]与幽门螺杆菌有关疾病\r\n[考点还原]（P364）\u201c幽门螺杆菌感染是最常见的病因\u201d（B对）。（P369）\u201c十二指肠球部溃疡患者的Hp感染率高达90％～100％\u201d（C对）。\r\n[解析]糜烂性胃炎、活动性胃炎、十二\r\n指肠球溃疡和十二指肠球炎均可在黏膜中检得幽门螺杆菌。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"221","all_num":"527","types":0,"pname":"内科学"},{"id":"4067","name":"胃酸缺乏常见于","data":{"A":"胃癌","B":"胃溃疡","C":"慢性胃体胃炎","D":"慢性胃窦胃炎"},"da_an":"A@C","typeid":"117","time":"2018-09-13 15:55:34","xiang_jie":"[考点]胃酸检查\r\n[考点还原]（八版病理学P189）\u201c表9-1  慢性萎缩性胃炎A、B型比较表\u201d（C对D错）。\r\n[解析]胃癌时胃酸缺乏，这常是癌性溃疡区别于良性溃疡的特点之一；慢性胃体胃炎时，因为泌胃酸的壁细胞受影响，故胃酸亦缺乏。而胃溃疡和慢性胃窦胃炎时胃酸常正常或稍减少。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"226","all_num":"543","types":0,"pname":"内科学"},{"id":"4069","name":"对发热、腹痛、血性腹水的患者应考虑：","data":{"A":"结核性腹膜炎","B":"门静脉血栓形成","C":"胰源性腹水","D":"门脉性肝硬化"},"da_an":"A@B@C","typeid":"117","time":"2018-09-13 15:56:04","xiang_jie":"[考点]结核性腹膜炎等的鉴别诊断\r\n[考点还原]（P382）\u201c（一）全身症状  结核毒血症常见，主要是低热与中等热\u201d。（P382）\u201c（二）腹痛  位于脐周、下腹或全腹，持续或阵发性隐痛\u201d。（P383）\u201c（二）腹水检验  腹水多为草黄色渗出液，静置后可自然凝固，少数为浑浊或淡血性，偶见乳糜性\u201d（A对）。（P424）\u201c（四）门静脉血栓形成或海绵样变  急性或亚急性发展时，表现为中、重度腹胀痛或突发剧烈腹痛、脾大、顽固性腹水、肠坏死、消化道出血及肝性脑病等，腹穿可抽出血性腹水\u201d（B对）。（P425）\u201c血性腹水应考虑合并肝癌、门静脉血栓形成及结核性腹膜炎\u201d（AB对D错）。（七版外科学P578）\u201c胰液中的各种酶被激活后发挥作用的共同结果是胰腺和胰周组织广泛充血、水肿甚至出血、坏死。并在腹腔和腹膜后渗出大量的液体\u201d（C对）。\r\n[解析]结核性腹膜炎为结核菌感染腹腔所致，故可有发热、腹痛、血性腹水；门静脉血栓形成可突然出现腹痛、血性腹水，有时也可伴低热；胰源性腹水为胰腺炎特别是出血坏死型胰腺炎及胰腺癌腹膜浸润所致，因此也有发热、腹痛和血性腹水。而单纯性门脉性肝硬化为漏出液，不发热，腹水亦非血性。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"193","all_num":"544","types":0,"pname":"内科学"},{"id":"4071","name":"关于肝硬化的治疗有","data":{"A":"代偿期用高热量、高蛋白及丰富维生素饮食","B":"同时选用多种保肝药物治疗","C":"肝硬化合并症治疗","D":"伴有慢性活动性肝炎者，可试用肾上腺皮质激素治疗"},"da_an":"A@C@D","typeid":"117","time":"2018-09-13 15:56:38","xiang_jie":"[考点]肝硬化的治疗\r\n[考点还原]（七版内科学P453）\u201c（一）一般治疗\u20262.饮食  以高热量、高蛋白（肝性脑病时饮食限制蛋白质，见第十六章）和维生素，丰富而易消化的食物为原则\u201d（A对）。（P426）\u201c4.保护肝细胞  保护肝细胞药物虽有一定药理学基础，但普遍缺乏循证医学证据，过多使用可加重肝脏负担\u201d（B错）。（P426）\u201c（二）门静脉高压症状及其并发症治疗\u201d（C对）。\r\n[解析]关于肝硬化的治疗，在代偿期以高热量、高蛋白质及丰富维生素饮食为宜，同时应对合并症如上消化道出血、感染、肝性昏迷等进行治疗，当病理组织和免疫学证实有慢性活动性肝炎时，试用肾上腺皮质激素治疗可能有效。所谓保肝药物治疗并无肯定疗效，多用反而可增加肝脏负担，因此同时选用多种保肝药物治疗是不正确的。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"208","all_num":"493","types":0,"pname":"内科学"},{"id":"4072","name":"结核性腹膜炎腹水性质可为：","data":{"A":"草黄色渗出液","B":"淡血色","C":"合并肝硬化的患者可接近漏出液","D":"乳糜性"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:57:08","xiang_jie":"[考点]结核性腹膜炎的腹水特点\r\n[考点还原]（P383）\u201c腹水多为草黄色渗出液（A对），静置后可自然凝固，少数为浑浊或淡血性（B对），偶见乳糜性（D对），比重一般超过1.018，蛋白质定性试验阳性，定量在30g/L以上，白细胞计数超过500×10\u2076/L，以淋巴细胞或单核细胞为主\u201d。\r\n[解析]结核性腹膜炎的腹水为草黄色渗出液，少数为淡血色，偶见乳糜性，当合并肝硬化时可接近漏出液，因此四个答案均正确。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"247","all_num":"501","types":0,"pname":"内科学"},{"id":"4077","name":"下列哪几项是肠结核必须手术治疗的指征","data":{"A":"肠梗阻","B":"急性肠穿孔","C":"慢性肠穿孔引起粪瘘经内科治疗不见好转","D":"肠道大量出血经积极抢救不能满意止血"},"da_an":"B@C@D","typeid":"117","time":"2018-09-13 15:57:41","xiang_jie":"[考点]肠结核手术治疗的适应证\r\n[考点还原]（P381）\u201c（三）手术治疗  适应证：①完全性肠梗阻或部分性肠梗阻内科治疗无效者（A错）；②急性肠穿孔（B对），或慢性肠穿孔瘘管形成经内科治疗而未能闭合者（C对）；③肠道大量出血经积极抢救不能有效止血者（D对）；④诊断困难需开腹探查者\u201d。\r\n[解析]肠结核发生急性肠穿孔或慢性肠穿孔引起粪瘘经内科治疗不见好转和肠道大量出血经积极抢救不能满意止血者必须手术治疗，而肠梗阻中只有完全性肠梗阻才必须手术，不完全肠梗阻还可非手术治疗。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"237","all_num":"478","types":0,"pname":"内科学"},{"id":"4080","name":"下列哪些物质中毒可采用腹膜透析","data":{"A":"苯巴比妥","B":"甲醇","C":"导眠能","D":"有机磷杀虫药"},"da_an":"A@B","typeid":"117","time":"2018-09-13 15:58:09","xiang_jie":"[考点]中毒时腹膜透析治疗的适应证\r\n[考点还原]（P880）\u201c1）血液透析：用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥（A对）、水杨酸类、甲醇（B对）、茶碱、乙二醇和锂等）。短效巴比妥类、格鲁米特（导眠能）（C错）和OPI（D错）因具有脂溶性，一般不进行血液透析\u201d。\r\n[解析]可用腹膜透析清除血液中的苯巴比妥和甲醇，但因导眠能（格鲁米特）和有机磷杀虫药是脂溶性物质，透析效果不好，所以不可采用腹膜透析。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"194","all_num":"459","types":0,"pname":"内科学"},{"id":"4092","name":"下列哪些是炎症性肠病的肠外表现","data":{"A":"杵状指","B":"虹膜睫状体炎","C":"口腔黏膜溃疡","D":"结节性红斑"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:58:41","xiang_jie":"[考点]炎症性肠病的肠外表现\r\n[考点还原]（P386）\u201c（三）肠外表现  包括外周关节炎、结节性红斑（D对）、坏疽性脓皮病、巩膜外层炎、前葡萄膜炎、口腔复发性溃疡（C对）等，这些肠外表现在结肠炎控制或结肠切除后可以可以缓解或恢复\u201d。\r\n[解析]炎症性肠病包括Crohn病和溃疡性结肠炎，均可有一些肠外表现，杵状指、虹膜睫状体炎、口腔黏膜溃疡和结节性红斑均可见到。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"201","all_num":"496","types":0,"pname":"内科学"},{"id":"4097","name":"下列哪些药物被认为可能诱发急性胰腺炎","data":{"A":"硫唑嘌呤","B":"四环素","C":"磺胺","D":"肾上腺糖皮质激素\t"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:59:12","xiang_jie":"[考点]急性胰腺炎的病因\r\n[考点还原]（P439）\u201c噻嗪类利尿剂、硫唑嘌呤（A对）、糖皮质激素（D对）、磺胺类（C对）等药物可促发急性胰腺炎\u201d。（七版内科学P470）\u201c已知应用某些药物如噻嗪类利尿剂、硫唑嘌呤（A对）、糖皮质激素（D对）、四环素（B对）、磺胺类（C对）等可直接损伤胰腺组织，可使胰液分泌或黏稠度增加，引起急性胰腺炎\u201d。\r\n[解析]这是道记忆题，已确认题中所列出的四种药物均可诱发急性胰腺炎，这些药物可使胰液分泌或其黏稠度增加。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"224","all_num":"473","types":0,"pname":"内科学"},{"id":"4103","name":"通过影响LES压，能促进胃食管反流病发生的是","data":{"A":"胆囊收缩素","B":"胰升糖素","C":"血管活性肠肽","D":"地西泮"},"da_an":"A@B@C@D","typeid":"117","time":"2018-08-06 12:21:26","xiang_jie":"[考点]胃食管反流病的病因和发病机制\r\n[考点还原]（P357）\u201c贲门失弛缓症手术后\u2026某些激素（如缩胆囊素、胰高血糖素、血管活性肠肽等）（ABC对）、食物（如高脂肪、巧克力等）、药物（如钙通道阻滞剂、地西泮（D对）等可引起LES功能障碍或一过性LES松弛延长\u201d。\r\n[解析]LES是食管下括约肌，是指食管末端约3〜4cm长的环形肌束，正常人休息时为一高压带，防止胃内容物反流入食管。一些因素可影响LESS,使之下降，促进胃食管反流病的发生。题中所列出的四种因素均可影响LES压，促进胃食管反流病的发生。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"230","all_num":"476","types":0,"pname":"内科学"},{"id":"4106","name":"可能逆转慢性胃炎病人胃黏膜之肠化和不典型增生的药物是","data":{"A":"β胡萝卜素","B":"维生素C","C":"维生素E","D":"叶酸"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:59:58","xiang_jie":"[考点]慢性胃炎的治疗\r\n[考点还原]（P366）\u201c（三）癌前状态处理  近年大样本的临床研究提示，口服选择性COX-2抑制剂塞来昔布对胃黏膜重度炎症、肠化、萎缩及异型增生的逆转有一定益处；也可适量补充复合维生素（ABCD对）和含硒食物等\u201d。\r\n[解析]慢性胃炎病人可有胃黏膜之肠化和不典型增生，题中所列出的四种药物为抗氧化维生素，均有可能帮助其逆转。但对较重的病变应定期做胃镜检查随访，对重度不典型增生宜手术治疗。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"216","all_num":"471","types":0,"pname":"内科学"},{"id":"4112","name":"治疗肠易激综合征可选用的药物有：","data":{"A":"胃肠解痉药","B":"止泻药","C":"泻药","D":"抗抑郁药"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 16:00:53","xiang_jie":"[考点]肠易激综合征（IBS）的治疗\r\n[考点还原]（P400）\u201c（二）药物对症治疗  1.解痉药（A对） 抗胆碱药可作为缓解腹痛的短期对症治疗\u20262.止泻药（B对） 洛哌丁胺或地芬诺酯止泻效果好，适用于腹泻症状较重者，但不宜长期使用。轻症者宜使用吸附止泻药如蒙脱石、药用炭等。3.泻药（C对）  对便秘型患者酌情使用泻药\u20264.抗抑郁药（D对） 对腹痛症状重，上述治疗无效且精神症状明显者可试用。临床研究表明这类药物甚至对不伴有明显精神症状者亦有一定疗效\u201d。\r\n[解析]IBS病人有腹痛，这是由于胃肠道平滑肌痉挛所致，所以可以用胃肠解痉药治疗腹痛；IBS病人还有腹泻或便秘，因此可以用止泻药或泻药治疗；IBS的发病还与精神因素有关，心理应激对胃肠道运动有明显影响，因此用抗抑郁药可能对改善症状有辅助作用。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"252","all_num":"463","types":0,"pname":"内科学"},{"id":"4122","name":"胃食管反流病的治疗目的是","data":{"A":"控制症状","B":"减少复发","C":"防止食管狭窄","D":"避免食管穿孔"},"da_an":"A@B@C","typeid":"117","time":"2018-09-13 16:02:14","xiang_jie":"[考点还原]（P358）\u201c（三）并发症  1.上消化道出血\u20262.食管狭窄\u20263.Barrett食管\u201d（C对）。（P358）\u201c目的在于控制症状、治愈食管炎、减少复发和防治并发症\u201d（AB对）。\r\n[考点]胃食管反流病的治疗目的[解析]胃食管反流病是指胃十二指肠内容物反流入食管引起烧心等症状及咽喉、气道等食管外的组织损害，治疗的目的是控制症状、减少复发和防止并发症（包括上消化道出血、食管狹窄、Barrett食管），达到治愈的目标。因此答案是ABC","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"235","all_num":"515","types":0,"pname":"内科学"},{"id":"10008","name":"关于肾上腺皮质激素治疗克罗恩病，下列哪项不正确：","data":{"A":"用于本病活动期，对控制症状有效","B":"长期应用可防止复发","C":"一般开始口服泼尼松每日40〜60mg","D":"严重者可静脉给药","E":"有瘘管形成者应慎用"},"da_an":"B","typeid":"117","time":"2018-10-30 17:34:33","xiang_jie":"[答案]B\r\n[考点]克罗恩病的治疗\r\n[考点还原]（P389）\u201c2.糖皮质激素\u2026一般予口服泼尼松0.75～1mg/kg，口服最大剂量一般为60mg/d（C对）；重症患者先予大剂量静脉滴注（D对）\u201d。（P392）\u201c（2）糖皮质激素：对控制病情活动有较好疗效\u201d（A对）。\r\n[解析]肾上腺皮质激素治疗克罗恩病不能防止复发，因此B是不正确的，其余各项均正确。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"362","all_num":"513","types":0,"pname":"内科学"},{"id":"10009","name":"肝性脑病时中枢神经系统的多巴胺合成减少，故应给予：","data":{"A":"多巴胺","B":"复方氨基酸溶液","C":"乙酰谷氨酰胺","D":"左旋多巴","E":"乳果糖"},"da_an":"D","typeid":"117","time":"2018-10-30 17:35:20","xiang_jie":"[考点]肝性脑病的治疗\r\n[考点还原]（七版药学类专业用药理学P297）\u201c（2）治疗肝性脑病：进入脑中的左旋多巴（D对）可以合成去甲肾上腺素，利于中枢神经系统功能的恢复，这样可以使肝性脑病的患者清醒，但是不能改善肝脏的功能\u201d。\r\n[解析]左旋多巴是多巴胺的前体，可透过血脑屏障进入脑组织，起到多巴胺的作用，而多巴胺不能透过血脑屏障，其他三种均与多巴胺无关。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"418","all_num":"476","types":0,"pname":"内科学"},{"id":"10010","name":"关于肝肾综合征，下列哪项不正确","data":{"A":"多发生于有大量腹水的失代偿期肝硬化","B":"表现为少尿或无尿","C":"肾衰竭为不可逆性","D":"低钠血症","E":"低尿钠症"},"da_an":"C","typeid":"117","time":"2018-10-30 17:37:10","xiang_jie":"[答案]C\r\n[考点]肝肾综合征的临床特点\r\n[考点还原]（七版内科学P450）\u201c（六）肝肾综合征\u2026主要见于伴有腹水的晚期肝硬化（A对）或急性肝功能衰竭的患者\u2026HRS临床表现为自发性少尿或无尿（B对），氮质血症和血肌酐升高，稀释性低钠血症（D对），低尿钠（E对）\u201d。（十四版实用内科学P2001）\u201c5.泌尿系统  肝肾综合征时，患者虽然有肾功能不全，但是肾脏可无组织学上改变，是可逆的循环相关性肾衰竭\u201d（C错，为本题正确答案）。\r\n[解析]肝肾综合征时，肾无重要病理改变，而是由于肾血管收缩引起的功能性肾衰竭，因而应该是可逆性的，而不是不可逆性的，其余各项均正确。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"420","all_num":"463","types":0,"pname":"内科学"},{"id":"10011","name":"男性，25岁，节律性间断上腹隐痛3年，加重2天，10小时前开始黑便3次，量约1000g,BP 9/6kPa（67.5/45mmHg）,P 120次/分，Hb 90g/L，首选下列哪种治疗：","data":{"A":"大量输液","B":"输右旋糖酐","C":"外科手术","D":"急诊内镜止血","E":"输血、补液"},"da_an":"E","typeid":"117","time":"2018-10-30 17:37:52","xiang_jie":"[答案]E\r\n[考点]溃疡病大出血的紧急治疗\r\n[考点还原]（P452）\u201c（一）呕血与黑粪  是上消化道出血的特征性表现，上消化道大量出血后，均有黑粪。出血部位在幽门以上者常伴有呕血\u2026黑粪呈柏油样，黏稠而发亮\u201d（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（E对）。\r\n[解析]根据简单病史，考虑此病人为溃疡病大量出血后伴低血压状态和急性失血性贫血，因而首选治疗应该是输血、补液，以迅速纠正低血压状态和贫血，其他治疗方法均不宜首选。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"350","all_num":"465","types":0,"pname":"内科学"},{"id":"10012","name":"关于球后溃疡的临床表现，下列哪项不符合：","data":{"A":"夜间痛常见","B":"痛常向背部放散","C":"症状较一般十二指肠溃疡严重而持续","D":"不易出血","E":"内科疗效差"},"da_an":"D","typeid":"117","time":"2018-10-30 17:38:33","xiang_jie":"[答案]D\r\n[考点]球后溃疡的临床表现特点\r\n[考点还原]（七版内科学P390）\u201c球后溃疡具有DU的临床特点，但午夜痛及背部放射痛多见（AB对），对药物治疗反应较差（E对），较易并发出血（D错，为本题正确答案）\u201d。\r\n[解析]球后溃疡易出血，发生率约60%，因而D不符合球后溃疡的临床表现，其余各项均符合。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"418","all_num":"455","types":0,"pname":"内科学"},{"id":"10013","name":"溃疡性结肠炎病变多位于：","data":{"A":"回肠末端及升结肠","B":"升结肠","C":"降结肠","D":"全结肠","E":"直肠及乙状结肠"},"da_an":"E","typeid":"117","time":"2018-10-30 17:39:06","xiang_jie":"[答案]E\r\n[考点]溃疡性结肠炎的好发部位\r\n[考点还原]（P385）\u201c病变多自直肠开始，逆行向近段发展，可累及全结肠甚至末端回肠\u201d（E对）。\r\n[解析]这是道记忆题，溃疡性结肠炎病变多位于直肠及乙状结肠，故答案是E。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"428","all_num":"470","types":0,"pname":"内科学"},{"id":"10014","name":"关于消化性溃疡的叙述，下列哪一项不正确：","data":{"A":"在临床上，十二指肠溃疡较胃溃疡多见","B":"绝大多数病例病变位于胃和十二指肠","C":"男性发病多于女性","D":"全世界均多见","E":"童年及老年均罕见"},"da_an":"E","typeid":"117","time":"2018-10-30 17:39:46","xiang_jie":"[考点]消化性溃疡的流行病学\r\n[考点还原]（P369）\u201c消化性溃疡是一种全球性常见病（D对），估计约有10％左右的人在其一生中患过本病。本病可发生于任何年龄段。十二指肠溃疡多（DU）多见于青壮年，而胃溃疡（GU）则多见于中老年（E错，为本题正确答案）；前者的发病高峰一般比后者早10年。临床上十二指肠球部溃疡多于胃溃疡（A对），十二指肠球部溃疡与胃溃疡发生率的比值大约为3：1。不论是胃溃疡还是十二指肠球部溃疡均好发于男性（C对）\u201d。\r\n[解析]消化性溃疡是人类的常见病，童年和老年亦非罕见，因而E是不正确的，其余各项均正确。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"396","all_num":"479","types":0,"pname":"内科学"},{"id":"10015","name":"血清碱性磷酸酶明显增高，可见于哪种黄疸","data":{"A":"肝细胞性黄疸","B":"溶血性黄疸","C":"Roter综合征引起的黄疸","D":"Gilbert综合征引起的黄疸","E":"阻塞性黄疸"},"da_an":"E","typeid":"117","time":"2018-10-30 17:40:20","xiang_jie":"[答案]E\r\n[考点]黄疸的鉴别诊断\r\n[考点还原]  八版生物化学未明确说明。\r\n[解析]血清碱性磷酸酶（ALP）大部分来源于肝脏和骨骼，主要经胆道排泄，当胆道疾病引起阻塞性黄疸时，由于ALP排泄减少而明显升高，因而血清ALP明显增高是阻塞性黄疸的特点，也是与其他各种黄疸的鉴别要点之一，所以答案应该是E，而其余各种黄疸均无血清碱性磷酸酶增高。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"226","all_num":"458","types":0,"pname":"内科学"},{"id":"10016","name":"服毒后的洗胃处理，下列哪项不正确：","data":{"A":"一般在服毒后6小时内洗胃有效","B":"超过6小时多数洗胃已无必要","C":"吞服强腐蚀性毒物者，不宜洗胃","D":"惊厥患者不宜插管洗胃","E":"昏迷患者插胃管易致吸入性肺炎，洗胃应慎重"},"da_an":"B","typeid":"117","time":"2018-10-30 17:40:55","xiang_jie":"[答案]B\r\n[考点]中毒的洗胃\r\n[考点还原]（P879）\u201c（3）洗胃  1）适应证：用于口服毒物1小时以内者；对于服用吸收缓慢的毒物、胃蠕动功能减弱或消失者，服毒4～6小时后仍应洗胃（B错，为本题正确答案）。2）禁忌证：吞服强腐蚀性毒物（C对）、食管静脉曲张、惊厥（D对）或昏迷（E对）患者，不宜进行洗胃\u201d。\r\n[解析]服毒后一般在6小时内洗胃肯定有效，但即使已超过6小时，由于部分毒物仍可滞留于胃内，多数仍有洗胃的必要，因而超过6小时多数洗胃已无必要是不正确的，其余关于洗胃的处理均是正确的。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"388","all_num":"420","types":0,"pname":"内科学"},{"id":"10017","name":"溃疡性结肠炎最多见的临床类型是","data":{"A":"初发型","B":"慢性复发型","C":"慢性持续型","D":"急性暴发型","E":"临床终末型"},"da_an":"B","typeid":"117","time":"2018-10-30 17:42:16","xiang_jie":"[考点]溃疡性结肠炎的临床分型\r\n[考点还原]（P386）\u201c慢性复发型：临床上最多见（B对），发作期与缓解期交替\u201d。\r\n[解析]溃疡性结肠炎按其病程、程度、范围及病期进行综合分型，可分为初发型、慢性复发型、慢性持续型和急性暴发型，其中以慢性复发型最多见。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"407","all_num":"504","types":0,"pname":"内科学"},{"id":"10018","name":"急性腐蚀性胃炎是由于吞服：","data":{"A":"硝酸","B":"盐酸","C":"水杨酸","D":"亚硝酸盐"},"da_an":"A@B","typeid":"117","time":"2018-10-30 17:43:45","xiang_jie":"[答案]AB\r\n[考点]急性腐蚀性胃炎的病因\r\n[考点还原]（P875）\u201c表9-2-1  常见急性中毒诊治要点\u201d（AB对）。\r\n[解析]引起急性腐蚀性胃炎的毒物是强酸或强碱类，因为硝酸和盐酸为强酸类，所以吞服后可引起急性腐蚀性胃炎，而水杨酸和亚硝酸盐属弱酸类，所以吞服后不会引起急性腐蚀性胃炎。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"227","all_num":"495","types":0,"pname":"内科学"},{"id":"10019","name":"下列关于胃的良性与恶性溃疡鉴别要点的叙述，正确的是：","data":{"A":"早期溃疡型胃癌单凭内镜所见不难与良性溃疡鉴别","B":"活组织检查可以确定良性或恶性溃疡","C":"即使内镜下诊断为良性溃疡且活检阴性，仍有漏诊恶性溃疡的可能","D":"胃镜复查溃疡愈合不是鉴别良性与恶性溃疡的可靠依据"},"da_an":"B@C@D","typeid":"117","time":"2018-10-30 17:45:03","xiang_jie":"[答案]BCD\r\n[考点]胃良性与恶性溃疡的鉴别\r\n[考点还原]（七版内科学P391）\u201cⅢ型（溃疡型） 早期胃癌单凭内镜所见与良性溃疡鉴别有困难（A错），放大内镜和染色内镜对鉴别有帮助，但最终必须依靠直视下取活组织检查鉴别（B对）\u201d。（七版内科学P391）\u201c即使内镜下诊断为良性溃疡且活检阴性，仍有漏诊胃癌的可能\u201d（C对）。（七版内科学P391）\u201c胃镜复查溃疡缩小或愈合不是鉴别良、恶性溃疡的最终依据，必须重复活检加以证实\u201d（D对）。\r\n[解析]内镜或X线检查见到胃的溃疡必须鉴别其为良性或恶性，早期溃疡型胃癌单凭内镜所见很难与良性溃疡鉴别，二者非常相似，必须依靠直视下取活组织检查鉴别，因此A项叙述是错误的，其余3项均正确。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"238","all_num":"518","types":0,"pname":"内科学"},{"id":"10508","name":"多灶萎缩性胃窦炎最主要的病因是","data":{"A":"胆汁反流   ","B":"口服非甾体抗炎药","C":"幽门螺杆菌感染 ","D":"自身免疫性抗体"},"da_an":"C","typeid":"117","time":"2018-11-24 10:36:48","xiang_jie":"C  ①慢性萎缩性胃炎分为多灶萎缩性胃炎和自身免疫性胃炎两类。前者好发于胃窦部，多由 幽门螺杆菌感染引起的慢性非萎缩性胃炎发展而来。后者好发于胃体部，多由自身免疫引起的胃体胃炎发展而来。参阅7版内科学P383。②胆汁反流、口服非甾体抗炎药物是慢性胃炎的少见病因。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"421","all_num":"518","types":0,"pname":"内科学"},{"id":"10509","name":"球后溃疡的临床特点是","data":{"A":"上腹痛常无典型的节律性    ","B":"午夜痛和背部放射痛多见","C":"对药物治疗反应较好 ","D":"不易并发出血"},"da_an":"B","typeid":"117","time":"2018-11-24 10:37:32","xiang_jie":"B 球后溃疡是指发生于十二指肠降段、水平段的溃疡，多具有十二指肠溃疡的临床特点，但夜间痛和背部放射痛更为多见，对药物治疗反应稍差，较易并发出血。参阅3版8年制内科学P468。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"441","all_num":"474","types":0,"pname":"内科学"},{"id":"10510","name":"男性，51岁。肝硬化病史4年，发生呕血、黑便2天，半天来出现意识模糊和躁动人院。为清除该患者的肠道内积血，最宜选用的灌肠液是","data":{"A":"弱酸性液    ","B":"弱碱性液  ","C":"肥皂水","D":"温开水"},"da_an":"A","typeid":"117","time":"2018-11-24 10:39:01","xiang_jie":"A  ①患者长期肝硬化病史，上消化道出血后突然出现意识障碍，应诊断为肝性脑病，为氨中毒所致。②NH4+不能通过血脑屏障达脑部，相对无毒。能通过血脑屏障，促发肝性脑病的神经毒素是NH3。NH，和NH4+的相互转化受pH梯度改变的影响，NH3在酸性环境下(pH<6．O)，可与H+结合形成毒性小的NH4+随粪便排出体外。在碱性环境下，如当结肠pH> 6.0时，NH4+离解为NH3和H+，NH，大量弥散人血，导致肝性脑病。为清除患者肠道内积血，减少血氨形成，可采用弱酸性溶液灌肠(A)。③肥皂水多为弱碱性溶液，会增加血氨吸收；温开水不能减少血氨形成，均不宜使用。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"384","all_num":"467","types":0,"pname":"内科学"},{"id":"10511","name":"男性，32岁。间断发作下腹痛、腹胀伴腹泻或便秘3年余，下腹痛不重，多于排 便后缓解，粪便常有黏液，无脓血。3周来再次发作下腹痛伴腹泻，大便2~4次／天，粪便性状同前。体楮检查除下腹部有轻度压痛外，其余未见异常。粪便常规、隐血及培养均未发现明显异常。患者最可能的诊断是","data":{"A":"肠结核 ","B":"克罗恩病","C":"肠易激综合征","D":"溃疡性结肠炎"},"da_an":"C","typeid":"117","time":"2018-11-24 10:43:34","xiang_jie":"①年轻患者，长期间断下腹痛，排便后可缓解，无脓血便，多种检查均为阴性，应孝虑功能性肠病（肠易激综合征）。肠结核、克罗恩病、溃疡性结肠炎均为器质性病变，粪便常规、隐血及培养均可有阳性发现。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"481","all_num":"507","types":0,"pname":"内科学"},{"id":"10512","name":"男性，32岁。间断发作下腹痛、腹胀伴腹泻或便秘3年余，下腹痛不重，多于排 便后缓解，粪便常有黏液，无脓血。3周来再次发作下腹痛伴腹泻，大便2~4次／天，粪便性状同前。体楮检查除下腹部有轻度压痛外，其余未见异常。粪便常规、隐血及培养均未发现明显异常。为确定诊断，最有意义的检查是","data":{"A":"PPD试验","B":"腹部B超 ","C":"钡剂灌肠 ","D":"结肠镜"},"da_an":"D","typeid":"117","time":"2018-11-24 10:45:02","xiang_jie":"②为明确肠易激综合征的诊断，应首选纤维结肠镜检查，若无阳性发现，有助于诊断(D)。PPD试验多用于诊断肠结核。腹部B超对肠易激综合征的诊断价值不大。钡剂灌肠多用于克罗恩病、溃疡性结肠炎的诊断。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"470","all_num":"496","types":0,"pname":"内科学"},{"id":"10513","name":"男性，32岁。间断发作下腹痛、腹胀伴腹泻或便秘3年余，下腹痛不重，多于排 便后缓解，粪便常有黏液，无脓血。3周来再次发作下腹痛伴腹泻，大便2~4次／天，粪便性状同前。体楮检查除下腹部有轻度压痛外，其余未见异常。粪便常规、隐血及培养均未发现明显异常。可选择的治疗是","data":{"A":"口服抗结核药","B":"口服柳氮磺吡啶","C":"口服匹维溴胺","D":"口服布地奈德"},"da_an":"C","typeid":"117","time":"2018-11-24 10:46:47","xiang_jie":"C  ①年轻患者，长期间断下腹痛，排便后可缓解，无脓血便，多种检查均为阴性，应孝虑功能性肠病（肠易激综合征）。肠结核、克罗恩病、溃疡性结肠炎均为器质性病变，粪便常规、隐血及培养均可有阳性发现。②为明确肠易激综合征的诊断，应首选纤维结肠镜检查，若无阳性发现，有助于诊断(D)。PPD试验多用于诊断肠结核。腹部B超对肠易激综合征的诊断价值不大。钡剂灌肠多用于克罗恩病、溃疡性结肠炎的诊断。③匹维溴胺为选择性作用于胃肠道平滑肌的钙通道阻滞剂，可缓解腹痛(C)。A多用于肠结核的治疗。BD多用于溃疡性结肠炎的治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"444","all_num":"501","types":0,"pname":"内科学"},{"id":"10514","name":"有机磷中毒时，患者的呼吸气味常是","data":{"A":"烂苹果味","B":"苦杏仁味","C":"蒜臭味","D":"腥臭味"},"da_an":"C","typeid":"117","time":"2018-11-24 10:51:38","xiang_jie":"①有机磷农药中毒时，患者的呼吸气味常呈蒜臭味(C)。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"393","all_num":"505","types":0,"pname":"内科学"},{"id":"10515","name":"氰化物中毒时，患者的呼吸气味常是","data":{"A":"烂苹果昧  ","B":"苦杏仁味","C":"蒜臭味 ","D":"腥臭味"},"da_an":"B","typeid":"117","time":"2018-11-24 10:52:56","xiang_jie":"①有机磷农药中毒时，患者的呼吸气味常呈蒜臭味②氰化物中毒时，患者的呼吸气味常呈苦杏仁味(B)。③糖尿病酮症酸中毒时，患者的呼吸气味常呈烂苹果味。肝性脑病患者呼吸气体呈腥臭味。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"490","all_num":"524","types":0,"pname":"内科学"},{"id":"10516","name":"有机磷中毒时的毒蕈碱样症状有","data":{"A":"腹痛、腹泻  ","B":"大汗、流涎","C":"肌纤维颤动  ","D":"瞳孔缩小"},"da_an":"A@B@D","typeid":"117","time":"2018-11-24 10:56:17","xiang_jie":"ABD  有机磷农药中毒可导致毒草碱样症状、烟碱样症状和中枢神经系统症状。ABD均属于毒蕈碱样症状，C为烟碱样症状。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"277","all_num":"499","types":0,"pname":"内科学"}],"ban_ben":null}
     * mas : 该类型下没有版本号!
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    private String ret;
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         * list : [{"id":"69","name":"阿司匹林引起NSAID溃疡的最主要致溃疡机制是：","data":{"A":"抑制COX-1","B":"抑制COX-2","C":"同时抑制COX-1和COX-2","D":"局部作用"},"da_an":"A","typeid":"117","time":"2005-07-01 14:38:19","xiang_jie":"[答案]A\r\n[考点]阿司匹林的作用机制\r\n[考点还原]（P363）\u201cNSAIDs致胃黏膜病变的主要机理是通过小肠吸收后，对黏膜COX-1抑制，因此，肠溶型的NSAIDs依旧可以导致急性胃炎\u201d（A对）。\r\n[解析]NSAID的系统作用主要是抑制环氧合酶（COX）。COX有两种异构体，即COX-1和COX-2。COX-1催化生理性前列腺素合成，参与机体正常生理功能调节及保护，如维持胃肠黏膜完整。COX-2主要在病理情况下由炎症刺激诱导产生，促进炎症部位前列腺素的合成。传统的NSAID如阿司匹林抑制了COX-1，使胃肠黏膜生理性前列腺素E合成不足，导致胃肠道出现黏膜病变（溃疡）。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"2042","all_num":"2706","types":0,"pname":"内科学"},{"id":"74","name":"原发性肝癌早期的转移方式主要是：","data":{"A":"肝外血转移","B":"淋巴转移","C":"种植转移","D":"肝内转移"},"da_an":"D","typeid":"117","time":"2005-07-01 14:40:10","xiang_jie":"[答案]D\r\n[考点]原发性肝癌的转移方式\r\n[考点还原]（P430）\u201c2.肝外转移①血行转移：最常见转移至肺\u2026②淋巴转移：常见肝门淋巴结转移\u2026③种植转移：少见\u2026女性可有卵巢转移\u201d（八版病理学P215）\u201c癌组织首先在肝内直接蔓延，易经肝内沿门静脉分支播散、转移，使肝内出现多处转移结节\u201d（14版实用内科学P2036）\u201c肝内血行转移发生最早，也最常见，是肝癌切除术后早期复发的主要原因\u201d（D对）。\r\n[解析]原发性肝癌是我国常见的恶性肿瘤之一。原发性肝癌早期的转移方式是肝内转移。而其他的转移方式（肝外血转移、淋巴转移、种植转移）均为肝外转移。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"2472","all_num":"2663","types":0,"pname":"内科学"},{"id":"79","name":"男性，53岁，肝硬化病史8年。5天来无明显原因出现腹胀，腹水迅速增加，脾脏进一步增大，体温正常。最可能发生的并发症是：","data":{"A":"原发性肝细胞癌","B":"原发性腹膜炎","C":"门静脉血栓形成","D":"肝肾综合征"},"da_an":"C","typeid":"117","time":"2005-07-01 14:41:56","xiang_jie":"[答案]C\r\n[考点]肝硬化并发症\r\n[考点还原]（P424）\u201c门静脉血栓形成的临床表现变化较大\u2026急性或亚急性发展时，表现为中重度腹胀或突发剧烈腹痛、脾大、顽固性腹水、肠坏死、消化道出血及肝性脑病等，腹穿可抽出出血性腹水\u201d（C对）。\r\n[解析]该中年男性患者有肝硬化病史，最近短期内无明显原因出现腹胀，腹水迅速增加，脾脏进一步增大，体温正常，最可能发生的并发症是门静脉血栓形成。其余选项亦均为肝硬化的并发症，但原发性肝细胞癌不会腹水如此迅速增加和脾脏进一步增大，而主要是肝脏增大；原发性腹膜炎主要是腹痛和发热，该患者不像；肝肾综合征是因肾血管收缩导致肾皮质血流量和肾小球滤过率持续降低引起功能性肾衰竭，其特征为自发性少尿、氮质血症、稀释性低钠血症、低尿钠、尿比重升高等，该患者也不可能。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1598","all_num":"2061","types":0,"pname":"内科学"},{"id":"84","name":"男性，54岁。近2个月来反酸、烧心，多于餐后出现，平卧位时明显，5天来情况严重，有时伴有胸骨后疼痛，ECG检查未见明显异常，胃镜检查可见食管黏膜破损融合。该患者最可能的诊断是：","data":{"A":"胃食管反流病","B":"心绞痛","C":"食管憩室炎","D":"食管癌"},"da_an":"A","typeid":"117","time":"2018-10-11 19:36:22","xiang_jie":"[考点]胃食管反流病的诊断和治疗\r\n\r\n[考点还原]（P357）\u201c1.典型症状烧心和反流是本病最常见和典型的症状\u2026烧心和反流常在餐后1小时出现，卧位、弯腰或腹压增高时可加重\u201d（P357）\u201c2.非典型症状胸痛由反流物刺激食管引起，发生在胸骨后\u201d（P358）\u201c（一）胃镜是诊断RE最准确的方法\u2026胃镜下RE分级（洛杉矶分级法）如下：正常：食管黏膜没有破损\u2026C级：黏膜破损有融合，但小于75%的食管周径；D级：黏膜破损融合，至少达到75%的食管周径\u201d（P358）\u201cGERD的诊断是基于：①有反流症状；②胃镜下发现RE；③食管过度酸反流的客观证据。如患者有典型的烧心和反酸症状，可作出GERD的初步诊断。胃镜检查如发现有RE并能排除其他原因引起的食管病变，本病诊断可成立\u201d（A对）。\r\n[解析]该中年男性患者主诉为反酸、烧心，多于餐后出现，平卧位时明显，胃镜检查可见食管黏膜破损融合，这些均支持胃食管反流病的诊断。胃食管反流病是指胃、十二指肠内容物反流入食管所引起烧心和反酸等症状，可有胸骨后痛，放射至后背肩部及耳部等，酷似心绞痛，疼痛与酸反流有关，故又称为非心源性胸痛。胃食管反流病选用的治疗是奥美拉唑，不需要手术，氢氧化铝的抗酸疗效差，硝酸甘油是适用于心绞痛。维持治疗选用的最佳药物也是奥美拉唑。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1952","all_num":"1992","types":0,"pname":"内科学"},{"id":"89","name":"男性，54岁。近2个月来反酸、烧心，多于餐后出现，平卧位时明显，5天来情况严重，有时伴有胸骨后疼痛，ECG检查未见明显异常，胃镜检查可见食管黏膜破损融合。选用的治疗是：","data":{"A":"氢氧化铝","B":"硝酸甘油","C":"奥美拉唑","D":"手术"},"da_an":"C","typeid":"117","time":"2018-10-10 00:26:40","xiang_jie":"[考点]胃食管反流病的诊断和治疗\r\n\r\n[考点还原]（P359）\u201c2.抑酸药对初次接受治疗的患者或有食管炎的患者宜以PPI治疗，以求迅速控制症状、治愈食管炎\u201d（P359）\u201cPPI\u2026适用于症状重、有严重食管炎的患者\u201d（C对）。\r\n[解析]该中年男性患者主诉为反酸、烧心，多于餐后出现，平卧位时明显，胃镜检查可见食管黏膜破损融合，这些均支持胃食管反流病的诊断。胃食管反流病是指胃、十二指肠内容物反流入食管所引起烧心和反酸等症状，可有胸骨后痛，放射至后背肩部及耳部等，酷似心绞痛，疼痛与酸反流有关，故又称为非心源性胸痛。胃食管反流病选用的治疗是奥美拉唑，不需要手术，氢氧化铝的抗酸疗效差，硝酸甘油是适用于心绞痛。维持治疗选用的最佳药物也是奥美拉唑。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1809","all_num":"1974","types":0,"pname":"内科学"},{"id":"97","name":"男性，54岁。近2个月来反酸、烧心，多于餐后出现，平卧位时明显，5天来情况严重，有时伴有胸骨后疼痛，ECG检查未见明显异常，胃镜检查可见食管黏膜破损融合。若维持治疗，选用的最佳药物是：","data":{"A":"雷尼替丁","B":"奥美拉唑","C":"硝酸异山梨酯","D":"顺铂和5-氟尿嘧啶"},"da_an":"B","typeid":"117","time":"2018-10-11 19:34:27","xiang_jie":"[考点]胃食管反流病的诊断和治疗\r\n\r\n[考点还原]（P357）\u201c烧心和反流是本病最常见和典型的症状...烧心是指胸骨后或剑突下烧灼感，常由胸骨下段向上延伸。烧心和反流常在餐后1小时出现，卧位、弯腰或腹压增高时可加重，部分患者烧心和反流症状可在夜间入睡时发生\u201d，（P359）\u201c（二）维持治疗...PPI和H\u2082RA均可用于维持治疗，PPI效果更优\u201d（B对）\r\n[解析]该中年男性患者主诉为反酸、烧心，多于餐后出现，平卧位时明显，胃镜检查可见食管黏膜破损融合，这些均支持胃食管反流病的诊断。胃食管反流病是指胃、十二指肠内容物反流入食管所引起烧心和反酸等症状，可有胸骨后痛，放射至后背肩部及耳部等，酷似心绞痛，疼痛与酸反流有关，故又称为非心源性胸痛。胃食管反流病选用的治疗是奥美拉唑，不需要手术，氢氧化铝的抗酸疗效差，硝酸甘油是适用于心绞痛。维持治疗选用的最佳药物也是奥美拉唑。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1796","all_num":"1930","types":0,"pname":"内科学"},{"id":"103","name":"诊断胃食管反流病最准确的方法是：","data":{"A":"食管吞钡X线检查","B":"食管测压","C":"24小时食管pH监测","D":"胃镜检查"},"da_an":"D","typeid":"117","time":"2005-07-01 14:51:10","xiang_jie":"[答案]D\r\n[考点]胃食管反流病的诊断\r\n[考点还原]（P358）\u201c（一）胃镜  是诊断RE最准确的方法，并能判断RE的严重程度和有无并发症\u201d（D对）。\r\n[解析]胃食管反流病是指胃、十二指肠内容物反流入食管所引起\u201c烧心\u201d等症状，并可导致食管和咽喉、气管等组织损害的疾病。胃镜下有反流性食管炎表现，有反流性食管炎的表现即可诊断。因此诊断胃食管反流病最准确的方法是胃镜检查。其他检查（食管吞钡X线检查、食管测压和24小时食管pH监测）对诊断有帮助，但不能确诊。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1278","all_num":"1448","types":0,"pname":"内科学"},{"id":"108","name":"临床上服用下列药物时，不影响对幽门螺杆菌病原检测的是：","data":{"A":"奥美拉唑","B":"枸橼酸铋钾","C":"米索前列醇","D":"呋喃唑酮"},"da_an":"C","typeid":"117","time":"2005-07-01 14:52:28","xiang_jie":"[答案]C\r\n[考点]幽门螺杆菌的治疗\r\n[考点还原]（P372）\u201cPPI可增强抗Hp抗生素的杀菌作用\u201d（A错）。（P373）\u201c铋剂还可通过包裹Hp菌体，干扰Hp代谢，发挥杀菌作用\u201d（B错）。\r\n[解析]质子泵抑制剂（如奥美拉唑）、胶体铋剂（如枸橼酸铋钾）和抗生素（如阿莫西林、克拉霉素、甲硝唑、替硝唑、四环素及呋喃唑酮等）可杀灭幽门螺杆菌，而米索前列醇对幽门螺杆菌无作用。所以临床上服用米索前列醇时，不影响对幽门螺杆菌病原的检测。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1144","all_num":"1430","types":0,"pname":"内科学"},{"id":"113","name":"男性，45岁。间断发生腹痛、腹泻5年，发作时大便2~4次/天，有时便中有黏液，无脓血，排便后腹痛可缓解，因再发1周来诊。查体：左下腹轻压痛。化验粪常规：WBC 0~1/HP，隐血试验（－），细菌培养（－）。该患者最可能的诊断是：","data":{"A":"慢性细菌性痢疾","B":"肠易激综合征","C":"克罗恩病","D":"溃疡性结肠炎"},"da_an":"B","typeid":"117","time":"2018-11-17 15:26:05","xiang_jie":"[答案]B\r\n[考点]肠易激综合征的诊断\r\n[考点还原]（P386）\u201c1.腹泻和黏液脓血便  见于绝大多数患者\u201d（P387）\u201c（二）粪便  肉眼观常有黏液脓血，显微镜检见红细胞和脓细胞\u201d（D错）。（P390）\u201c体检常有腹部压痛，部位多在右下腹\u201d（C错）。（P399）\u201c患者以中青年居多\u201d（P400）\u201c症状反复发作或慢性迁延\u2026几乎所有IBS患者都有不同程度的腹痛或腹部不适，部位不定，以下腹和左下腹多见，排便或排气后缓解。极少有睡眠中痛醒者。腹泻型IBS常排便较急，粪便呈糊状或稀水样便，一般每日3～5次左右，少数严重发作期可达十余次，可带有黏液，但无脓血\u201d（B对）。（八版病理P360）\u201c由于炎症刺激\u2026导致里急后重和排便次数增多\u2026最初为稀便混有黏液，后转为黏液脓血便，偶尔排出片状假膜\u201d（A错）。\r\n[解析]该中年男性患者呈慢性病程，间断发生腹痛、腹泻，发作时大便次数增多（2〜4次/天），有时便中有黏液，但无脓血，排便后腹痛可缓解，结合左下腹轻压痛及化验粪常规见极少WBC（0〜1/HP）、隐血试验（－），细菌培养（－），该患者最可能的诊断是肠易激综合征。而其他疾病（慢性细菌性痢疾、克罗恩病和溃疡性结肠炎）大便均有脓血，慢性细菌性痢疾的粪细菌培养常阳性。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1083","all_num":"1367","types":0,"pname":"内科学"},{"id":"122","name":"女性，26岁。腹胀、腹痛伴低热、盗汗3个月。查体发现腹部移动性浊音阳性。化验血HBsAg（＋）。腹水常规：比重1.023，蛋白定量38g/L，白细胞数610×106/L，其中单个核细胞为80%。 该患者最可能的诊断是：","data":{"A":"肝硬化合并自发性腹膜炎","B":"结核性腹膜炎","C":"肝炎后肝硬化失代偿期","D":"肝癌腹膜转移"},"da_an":"B","typeid":"117","time":"2018-11-17 15:27:47","xiang_jie":"[答案]B\r\n    [解析]该青年女性患者呈慢性病程，腹胀、腹痛伴低热、盗汗，查体发现有腹水。腹水常规为渗出液（比重＞1.018，蛋白定量＞30g/L,白细胞数＞500×106/L），腹水白细胞中以单个核细胞为主（80%）。因此该患者最可能的诊断是结核性腹膜炎。腹水腺苷脱氨酶升高（>40U/L）的检查结果最支持结核性腹膜炎的诊断，该患者的ADA为79.5U/L，因此该检查结果支持上述诊断。血清一腹水白蛋白梯度（SAAG）12g/L支持肝硬化合并自发性腹膜炎的诊断（SAAG＞11g/L）；腹水病理检查见到癌细胞和腹水培养见到来自肠道的革兰阴性菌均不支持结核性腹膜炎的诊断。该患者诊断为结核性腹膜炎，所以最宜选用的治疗是抗结核治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1094","all_num":"1367","types":0,"pname":"内科学"},{"id":"126","name":"女性，26岁。腹胀、腹痛伴低热、盗汗3个月。查体发现腹部移动性浊音阳性。化验血HBsAg（＋）。腹水常规：比重1.023，蛋白定量38g/L，白细胞数610×106/L，其中单个核细胞为80%。下列检查结果支持上述诊断的是：","data":{"A":"腹水腺苷脱氨酶（ADA） 79.5U/L","B":"血清-腹水白蛋白梯度（SAAG） 12g/L","C":"腹水病理检查见到癌细胞","D":"腹水培养见到来自肠道的革兰阴性菌"},"da_an":"A","typeid":"117","time":"2018-11-17 15:28:12","xiang_jie":"[答案]A\t\r\n    [解析]该青年女性患者呈慢性病程，腹胀、腹痛伴低热、盗汗，查体发现有腹水。腹水常规为渗出液（比重＞1.018，蛋白定量＞30g/L,白细胞数＞500×106/L），腹水白细胞中以单个核细胞为主（80%）。因此该患者最可能的诊断是结核性腹膜炎。腹水腺苷脱氨酶升高（>40U/L）的检查结果最支持结核性腹膜炎的诊断，该患者的ADA为79.5U/L，因此该检查结果支持上述诊断。血清一腹水白蛋白梯度（SAAG）12g/L支持肝硬化合并自发性腹膜炎的诊断（SAAG＞11g/L）；腹水病理检查见到癌细胞和腹水培养见到来自肠道的革兰阴性菌均不支持结核性腹膜炎的诊断。该患者诊断为结核性腹膜炎，所以最宜选用的治疗是抗结核治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1133","all_num":"1319","types":0,"pname":"内科学"},{"id":"129","name":"女性，26岁。腹胀、腹痛伴低热、盗汗3个月。查体发现腹部移动性浊音阳性。化验血HBsAg（＋）。腹水常规：比重1.023，蛋白定量38g/L，白细胞数610×106/L，其中单个核细胞为80%。该患者最宜选用的治疗是：","data":{"A":"对症支持治疗","B":"应用广谱抗生素","C":"抗结核治疗","D":"全身联合肿瘤化疗"},"da_an":"C","typeid":"117","time":"2018-11-17 15:28:31","xiang_jie":"[答案]C\r\n    [解析]该青年女性患者呈慢性病程，腹胀、腹痛伴低热、盗汗，查体发现有腹水。腹水常规为渗出液（比重＞1.018，蛋白定量＞30g/L,白细胞数＞500×106/L），腹水白细胞中以单个核细胞为主（80%）。因此该患者最可能的诊断是结核性腹膜炎。腹水腺苷脱氨酶升高（>40U/L）的检查结果最支持结核性腹膜炎的诊断，该患者的ADA为79.5U/L，因此该检查结果支持上述诊断。血清一腹水白蛋白梯度（SAAG）12g/L支持肝硬化合并自发性腹膜炎的诊断（SAAG＞11g/L）；腹水病理检查见到癌细胞和腹水培养见到来自肠道的革兰阴性菌均不支持结核性腹膜炎的诊断。该患者诊断为结核性腹膜炎，所以最宜选用的治疗是抗结核治疗。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1274","all_num":"1297","types":0,"pname":"内科学"},{"id":"134","name":"粪隐血试验阳性，消化道最小出血量应是：","data":{"A":"5ml","B":"10ml","C":"30ml","D":"50ml"},"da_an":"A","typeid":"117","time":"2005-07-01 15:03:16","xiang_jie":"[答案]A\r\n[考点]上消化道出血\r\n[考点还原]（P453）\u201c（二）出血程度的评估和周围循环状态的判断  成人每日消化道出血＞5ml（A对），粪便潜血试验即出现阳性\u201d。\r\n[解析]这是一道记忆型题，粪隐血试验阳性，消化道最小出血量应是5ml。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1162","all_num":"1292","types":0,"pname":"内科学"},{"id":"137","name":"在急性胰腺炎发病过程中起关键作用的酶是：","data":{"A":"淀粉酶","B":"弹力纤维酶","C":"胰蛋白酶","D":"激肽酶"},"da_an":"C","typeid":"117","time":"2005-07-01 15:04:27","xiang_jie":"[答案]C\r\n[考点]急性胰腺炎的发病机制\r\n[考点还原]（七版内科学P470）\u201c首先激活胰蛋白酶原，形成胰蛋白酶（C对），在胰蛋白酶作用下使各种胰消化酶原激活为有生物活性的消化酶\u2026一旦各种消化酶原激活后，其中其主要作用的活化酶有磷脂酶A\u2082、激肽释放酶或胰舒血管素、弹性蛋白酶和脂肪酶\u2026上述消化酶共同作用，造成胰腺实质及邻近组织的病变\u201d。\r\n[解析]急性胰腺炎是由多种病因导致胰腺组织自身消化所致的胰腺水肿、出血及坏死等炎性损伤。正常胰腺分泌的消化酶有两种形式，一种是有活性的酶如脂肪酶、淀粉酶和核糖核酸酶等；另一种是无活性的如胰蛋白酶原等。正常人胰腺腺泡的胰管内含有胰蛋白酶抑制物质，有避免胰蛋白酶原激活后的自身消化作用。急性胰腺炎时，各种原因导致胰腺腺泡内无活性的胰蛋白酶原激活，产生胰腺自身消化而发病.所以在急性胰腺炎发病过程中起关键作用的酶是胰蛋白酶。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"930","all_num":"1311","types":0,"pname":"内科学"},{"id":"140","name":"女性，20岁。误服有机磷农药后半小时家人送来急诊。查体：神志不清，皮肤潮湿多汗，面部肌肉束颤动，瞳孔缩小，双肺布满湿啰音。该患者最可能的中毒程度是：","data":{"A":"轻度","B":"中度","C":"重度","D":"不能确定"},"da_an":"C","typeid":"117","time":"2018-10-18 00:57:25","xiang_jie":"[答案]C\r\n[考点]有机磷农药中毒程度分级\r\n[考点还原]（P886）\u201c（三）急性中毒诊断分级  1.轻度中毒  仅有M样症状，ChE活力70％～50％。2.中度中毒  M样症状加重，出现N样症状，ChE活力50％～30％。3.重度中毒（C对） 具有M、N样症状，并伴有肺水肿、抽搐、昏迷，呼吸肌麻痹和脑水肿，ChE活力30％以下\u201d。\r\n[解析]该青年女性患者误服有机磷农药中毒，已神志不清，有M样症状（皮肤潮湿多汗、瞳孔缩小）、N样症状（面部肌肉束颤动）及肺水肿（双肺布满湿啰音）。临床中毒程度分度：①轻度中毒：以M样症状为主，胆碱酯酶活力70%〜50%；②中度中毒：M样症状加重，出现N样症状，胆碱酯酶活力50%〜30%；③重度中毒：除M、N样症状外，合并肺水肿、抽搐、昏迷、呼吸肌麻痹和脑水肿，胆碱酯酶活力在30%以下。因此该患者最可能的中毒程度是重度。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"902","all_num":"1143","types":0,"pname":"内科学"},{"id":"146","name":"男性，46岁。2年来消瘦、乏力，近5天来发热、嗜睡，1天来不省人事急诊入院，既往患乙型肝炎多年。查体：T 37.5℃，P 86次/分，R 20次/分，BP 120/80mmHg，神志不清，前胸部可见蜘蛛痣，巩膜轻度黄染，颈软，甲状腺不大，心肺检查未见异常，腹平软，肝肋下未及，脾肋下4cm，移动性浊音阳性。尿常规无异常，化验Hb 110g/L.WBC 3.4×109/L，Plt 92×109/L。 该患者最可能的诊断是：","data":{"A":"肺性脑病","B":"肝性脑病","C":"尿毒症昏迷","D":"脑血管意外"},"da_an":"B","typeid":"117","time":"2005-07-01 15:07:45","xiang_jie":"[答案]B\t\r\n[考点]肝性脑病的诊断和治疗\r\n    [考点还原]（P421）\u201c（二）失代偿期\u20261.肝功能减退\u2026（2）营养不良：一般情况较差，消瘦、乏力，精神不振\u2026（3）黄疸：皮肤、巩膜黄染，尿色深\u20262.门脉高压\u2026（3）脾功能亢进及脾大\u2026脾功能亢进时，患者外周血象呈白细胞减少、增生性贫血和血小板降低\u201d（P435）\u201c【临床表现】 主要表现为高级神经中枢的功能紊乱（如性格改变、智力下降、行为失常、意识障碍等）\u201d（B对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（D对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（P437）\u201c（四）促进体内氨的代谢\u20263.其它  谷氨酸钠或钾、精氨酸等药物理论上具有降血氨作用\u201d（A对）。\r\n[解析]该中年男性患者慢性病程，患乙型肝炎多年，根据病史（消瘦、乏力，近5天来发热、嗜睡，1天来不省人事）和体征（蜘蛛痣、巩膜黄染、脾大、移动性浊音阳性）符合乙型肝炎肝硬化，并引起肝性脑病，其他引起昏迷的疾病均不符合。为明确肝性脑病的诊断，首选的检查是血氨。因为肝性脑病的发病机制可能是氨中毒，所以应选择的治疗措施是降血氨药物如谷氨酸钾，其余均不是针对该患者的发病机制的治疗措施。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1130","all_num":"1180","types":0,"pname":"内科学"},{"id":"154","name":"男性，46岁。2年来消瘦、乏力，近5天来发热、嗜睡，1天来不省人事急诊入院，既往患乙型肝炎多年。查体：T 37.5℃，P 86次/分，R 20次/分，BP 120/80mmHg，神志不清，前胸部可见蜘蛛痣，巩膜轻度黄染，颈软，甲状腺不大，心肺检查未见异常，腹平软，肝肋下未及，脾肋下4cm，移动性浊音阳性。尿常规无异常，化验Hb 110g/L.WBC 3.4×109/L，Plt 92×109/L。为明确诊断，首选的检查是：","data":{"A":"肝肾功能","B":"动脉血气分析","C":"头颅CT","D":"血氨"},"da_an":"D","typeid":"117","time":"2005-07-01 15:09:32","xiang_jie":"[答案]D \r\n[考点]肝性脑病的诊断和治疗\r\n    [考点还原]（P421）\u201c（二）失代偿期\u20261.肝功能减退\u2026（2）营养不良：一般情况较差，消瘦、乏力，精神不振\u2026（3）黄疸：皮肤、巩膜黄染，尿色深\u20262.门脉高压\u2026（3）脾功能亢进及脾大\u2026脾功能亢进时，患者外周血象呈白细胞减少、增生性贫血和血小板降低\u201d（P435）\u201c【临床表现】 主要表现为高级神经中枢的功能紊乱（如性格改变、智力下降、行为失常、意识障碍等）\u201d（B对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（D对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（P437）\u201c（四）促进体内氨的代谢\u20263.其它  谷氨酸钠或钾、精氨酸等药物理论上具有降血氨作用\u201d（A对）。\r\n[解析]该中年男性患者慢性病程，患乙型肝炎多年，根据病史（消瘦、乏力，近5天来发热、嗜睡，1天来不省人事）和体征（蜘蛛痣、巩膜黄染、脾大、移动性浊音阳性）符合乙型肝炎肝硬化，并引起肝性脑病，其他引起昏迷的疾病均不符合。为明确肝性脑病的诊断，首选的检查是血氨。因为肝性脑病的发病机制可能是氨中毒，所以应选择的治疗措施是降血氨药物如谷氨酸钾，其余均不是针对该患者的发病机制的治疗措施。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1033","all_num":"1140","types":0,"pname":"内科学"},{"id":"159","name":"男性，46岁。2年来消瘦、乏力，近5天来发热、嗜睡，1天来不省人事急诊入院，既往患乙型肝炎多年。查体：T 37.5℃，P 86次/分，R 20次/分，BP 120/80mmHg，神志不清，前胸部可见蜘蛛痣，巩膜轻度黄染，颈软，甲状腺不大，心肺检查未见异常，腹平软，肝肋下未及，脾肋下4cm，移动性浊音阳性。尿常规无异常，化验Hb 110g/L.WBC 3.4×109/L，Plt 92×109/L。针对该患者的发病机制，应选择的治疗措施是：","data":{"A":"降血氨药物如谷氨酸钾","B":"纠正水、电解质紊乱","C":"机械通气","D":"降颅压治疗"},"da_an":"A","typeid":"117","time":"2005-07-01 15:11:31","xiang_jie":"[答案]A\r\n[考点]肝性脑病的诊断和治疗\r\n    [考点还原]（P421）\u201c（二）失代偿期\u20261.肝功能减退\u2026（2）营养不良：一般情况较差，消瘦、乏力，精神不振\u2026（3）黄疸：皮肤、巩膜黄染，尿色深\u20262.门脉高压\u2026（3）脾功能亢进及脾大\u2026脾功能亢进时，患者外周血象呈白细胞减少、增生性贫血和血小板降低\u201d（P435）\u201c【临床表现】 主要表现为高级神经中枢的功能紊乱（如性格改变、智力下降、行为失常、意识障碍等）\u201d（B对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（D对）。（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（P435）\u201c2.血氨  肝硬化及门-体分流后的肝性脑病患者多有血氨升高\u201d（P437）\u201c（四）促进体内氨的代谢\u20263.其它  谷氨酸钠或钾、精氨酸等药物理论上具有降血氨作用\u201d（A对）。\r\n[解析]该中年男性患者慢性病程，患乙型肝炎多年，根据病史（消瘦、乏力，近5天来发热、嗜睡，1天来不省人事）和体征（蜘蛛痣、巩膜黄染、脾大、移动性浊音阳性）符合乙型肝炎肝硬化，并引起肝性脑病，其他引起昏迷的疾病均不符合。为明确肝性脑病的诊断，首选的检查是血氨。因为肝性脑病的发病机制可能是氨中毒，所以应选择的治疗措施是降血氨药物如谷氨酸钾，其余均不是针对该患者的发病机制的治疗措施。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1043","all_num":"1114","types":0,"pname":"内科学"},{"id":"165","name":"对早期肝性脑病诊断价值最大的检查结果是：","data":{"A":"定向力障碍","B":"心理智能检查异常","C":"扑翼样震颤","D":"病理征阳性"},"da_an":"B","typeid":"117","time":"2005-07-01 15:13:02","xiang_jie":"[答案]B\r\n[考点]肝性脑病的临床表现和诊断\r\n    [考点还原]（P435）\u201c0期（潜伏期） 又称轻微肝性脑病，无行为、性格异常，无神经系统病理征，脑电图正常，只在心理测试或智力测试时有轻微异常\u201d（B对）。（P435）\u201c1期（前驱期） 轻度性格改变和精神异常，如焦虑、欣快激动、淡漠、睡眠倒错、健忘等，可有扑翼样震颤（D错），脑电图多数正常。此期临床表现不明显，易被忽略\u201d。（P435）\u201c2期（昏迷前期） 嗜睡、行为异常（如衣冠不整或随地大小便）、言语不清、书写障碍及定向力障碍（A错）。有腱反射亢进、肌张力增高、踝阵挛及Babinski征阳性等神经体征（C错），有扑翼样震颤，脑电图有特征性异常\u201d。\r\n[解析]肝性脑病主要表现为高级神经中枢功能紊乱及运动和反射异常，其临床过程分为5期，早期即0期（潜伏期）仅在心理智能检查时有轻微异常。扑翼样震颤出现在1、2、3期；定向力障碍和病理征阳性均出现在2期以后。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"930","all_num":"1138","types":0,"pname":"内科学"},{"id":"173","name":"肝硬化患者发生肝肾综合征时的特点是：","data":{"A":"血BUN升高、血钠升高、尿钠降低","B":"血BUN升高、血钠降低、尿钠升高","C":"血BUN升高、血钠降低、尿钠降低","D":"血BUN降低、血钠降低、尿钠升高"},"da_an":"C","typeid":"117","time":"2005-07-01 15:14:25","xiang_jie":"[答案]C\r\n[考点]肝硬化并发症（肝肾综合征）\r\n[考点还原]（七版内科学P450） \u201c（六）肝肾综合征\u2026HRS临床表现为自发性少尿或无尿，氮质血症和血肌酐升高，稀释性低钠血症，低尿钠\u201d（C对）。\r\n[解析]肝肾综合征是肝硬化患者的并发症之一，是由于肾皮质血流量和肾小球滤过持续降低引起功能性肾衰竭，其特征为自发性少尿、氮质血症、稀释性低钠血症、低尿钠、尿比重升高，但肾却无重要病理改变。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"843","all_num":"1110","types":0,"pname":"内科学"},{"id":"177","name":"男性，32岁。3个多月来低热、乏力、大便稀、右下腹痛、体重减轻。查体：T 37.6℃,P 84次/分，BP 110/70mmHg，心肺检查未见异常。腹软，右下腹轻压痛，肝脾肋下未触及，肠鸣音活跃。化验血Hb 125g/L,WBC 5.4×109/L,Plt252×109/L，粪常规偶见WBC。结肠镜检查示回盲部肠黏膜充血水肿，横行溃疡形成，肠腔狭窄，大小及形态各异的炎性息肉。最可能的诊断是：","data":{"A":"克罗恩病","B":"阿米巴肉芽肿","C":"结肠癌","D":"肠结核"},"da_an":"D","typeid":"117","time":"2005-07-01 15:15:42","xiang_jie":"[答案]D\r\n[考点]肠结核的诊断\r\n[考点还原]（P379）\u201c（一）腹痛  多位于右下腹或脐周\u201d（P379）\u201c（二）大便习惯改变  溃疡型肠结核常伴腹泻，粪便呈糊状，多无脓血\u201d（P380）\u201c（四）全身症状和肠外结核表现  结核毒血症状多见于溃疡性肠结核，为长期不规则低热、盗汗、消瘦、贫血和乏力\u201d（P380）\u201c（一）实验室  粪便中可见少量脓细胞和红细胞\u201d（P380）\u201c（三）结肠镜  内镜下见回盲部等处黏膜充血、水肿，溃疡形成，大小及形态各异的炎症息肉，肠腔变窄等\u201d（P381）\u201c表4-7-1  肠结核与克罗恩病的鉴别\u201d（D对）。\r\n[解析]该青年男性患者慢性病程，有低热、乏力、大便稀、右下腹痛、体重减轻，查体见右下腹轻压痛，肠鸣音活跃，应高度怀疑肠结核。结肠镜检查见有典型的肠结核特点，即回盲部肠黏膜充血水肿，横行溃疡形成，肠腔狭窄，大小及形态各异的炎性息肉。因此最可能的诊断是肠结核。其余均不符合。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"927","all_num":"1101","types":0,"pname":"内科学"},{"id":"181","name":"男性，26岁。排柏油便2天，加重伴头晕、心慌半天急诊入院。既往无肝病史，近期无服药史。查体：BP 70/40mmHg，心率120次/分，腹平软，无压痛，肝、脾肋下未触及，四肢末梢发凉。 该患者最可能的诊断是：","data":{"A":"急性胃炎","B":"胃癌","C":"十二指肠溃疡","D":"肝硬化食管静脉曲张破裂出血"},"da_an":"C","typeid":"117","time":"2005-07-01 15:17:20","xiang_jie":"[答案]C\t\r\n[考点]十二指肠溃疡出血的诊断和处理\r\n[考点还原]（P369）\u201c【流行病学】\u2026十二指肠溃疡多见于青壮年\u201d（P452）\u201c（一）呕血与黑粪  是上消化道出血的特征性表现，上消化道大量出血后，均有黑粪。出血部位在幽门以上者常用呕血\u2026黑粪呈柏油样，黏稠而发亮\u201d（P453）\u201c（三）失血性周围循环衰竭  急性大量出血由于循环血容量迅速减少而导致周围循环衰竭。表现为头昏、心慌、乏力，突然起立发生晕厥、肢体冷感、心率加快、血压偏低等。严重者呈休克状态\u201d（C对）。（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（C对）。（P454）\u201c（1）胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（A对）。\r\n[解析]该青年男性患者急性病程，排柏油便伴出血引起的头晕、心慌等症状，而且已达到休克状态（血压低，心率快，四肢末梢发凉），该患者为上消化道出血，因为消化性溃疡是上消化道出血最常见的原因，所以考虑该患者最可能的诊断是十二指肠溃疡；因为既往无肝病史，近期无服药史，而且无呕血，所以不支持肝硬化食管静脉曲张破裂出血和急性胃炎，年轻患者急性发病伴严重出血，也不支持胃癌出血。由于该患者已达到休克状态，所以首选的处理是补充血容量。待病情稳定后，为明确诊断，最重要的检查方法是胃镜检查，其余检查方法均不如胃镜检查好。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"820","all_num":"1133","types":0,"pname":"内科学"},{"id":"188","name":"男性，26岁。排柏油便2天，加重伴头晕、心慌半天急诊入院。既往无肝病史，近期无服药史。查体：BP 70/40mmHg，心率120次/分，腹平软，无压痛，肝、脾肋下未触及，四肢末梢发凉。首选的处理是：","data":{"A":"胃镜止血","B":"三腔二囊管压迫止血","C":"补充血容量","D":"急诊手术治疗"},"da_an":"C","typeid":"117","time":"2005-07-01 15:19:06","xiang_jie":"[答案]C\t\r\n[考点]十二指肠溃疡出血的诊断和处理\r\n[考点还原]（P369）\u201c【流行病学】\u2026十二指肠溃疡多见于青壮年\u201d（P452）\u201c（一）呕血与黑粪  是上消化道出血的特征性表现，上消化道大量出血后，均有黑粪。出血部位在幽门以上者常用呕血\u2026黑粪呈柏油样，黏稠而发亮\u201d（P453）\u201c（三）失血性周围循环衰竭  急性大量出血由于循环血容量迅速减少而导致周围循环衰竭。表现为头昏、心慌、乏力，突然起立发生晕厥、肢体冷感、心率加快、血压偏低等。严重者呈休克状态\u201d（C对）。（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（C对）。（P454）\u201c（1）胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（A对）。\r\n[解析]该青年男性患者急性病程，排柏油便伴出血引起的头晕、心慌等症状，而且已达到休克状态（血压低，心率快，四肢末梢发凉），该患者为上消化道出血，因为消化性溃疡是上消化道出血最常见的原因，所以考虑该患者最可能的诊断是十二指肠溃疡；因为既往无肝病史，近期无服药史，而且无呕血，所以不支持肝硬化食管静脉曲张破裂出血和急性胃炎，年轻患者急性发病伴严重出血，也不支持胃癌出血。由于该患者已达到休克状态，所以首选的处理是补充血容量。待病情稳定后，为明确诊断，最重要的检查方法是胃镜检查，其余检查方法均不如胃镜检查好。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"855","all_num":"1089","types":0,"pname":"内科学"},{"id":"195","name":"男性，26岁。排柏油便2天，加重伴头晕、心慌半天急诊入院。既往无肝病史，近期无服药史。查体：BP 70/40mmHg，心率120次/分，腹平软，无压痛，肝、脾肋下未触及，四肢末梢发凉。为明确诊断，最重要的检查方法是：","data":{"A":"稳定后胃镜检查","B":"稳定后X线钡餐检查","C":"腹部B型超声检查","D":"血清CEA测定"},"da_an":"A","typeid":"117","time":"2005-07-01 15:20:43","xiang_jie":"[答案]A\r\n[考点]十二指肠溃疡出血的诊断和处理\r\n[考点还原]（P369）\u201c【流行病学】\u2026十二指肠溃疡多见于青壮年\u201d（P452）\u201c（一）呕血与黑粪  是上消化道出血的特征性表现，上消化道大量出血后，均有黑粪。出血部位在幽门以上者常用呕血\u2026黑粪呈柏油样，黏稠而发亮\u201d（P453）\u201c（三）失血性周围循环衰竭  急性大量出血由于循环血容量迅速减少而导致周围循环衰竭。表现为头昏、心慌、乏力，突然起立发生晕厥、肢体冷感、心率加快、血压偏低等。严重者呈休克状态\u201d（C对）。（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（C对）。（P454）\u201c（1）胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（A对）。\r\n[解析]该青年男性患者急性病程，排柏油便伴出血引起的头晕、心慌等症状，而且已达到休克状态（血压低，心率快，四肢末梢发凉），该患者为上消化道出血，因为消化性溃疡是上消化道出血最常见的原因，所以考虑该患者最可能的诊断是十二指肠溃疡；因为既往无肝病史，近期无服药史，而且无呕血，所以不支持肝硬化食管静脉曲张破裂出血和急性胃炎，年轻患者急性发病伴严重出血，也不支持胃癌出血。由于该患者已达到休克状态，所以首选的处理是补充血容量。待病情稳定后，为明确诊断，最重要的检查方法是胃镜检查，其余检查方法均不如胃镜检查好。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1034","all_num":"1064","types":0,"pname":"内科学"},{"id":"199","name":"与幽门螺杆菌感染无关的疾病是：","data":{"A":"胃炎","B":"胃溃疡","C":"十二指肠溃疡","D":"胃食管反流病"},"da_an":"D","typeid":"117","time":"2005-07-01 15:21:45","xiang_jie":"[答案]D\r\n[考点]幽门螺杆菌感染\r\n[考点还原]（P357）\u201c（一）抗反流屏障结构与功能异常\u2026（二）食管清除作用降低\u2026（三）食管黏膜屏障功能降低\u201d（D对）。（P364）\u201c（一）Hp感染\u201d（A错）。（P369）\u201cHp感染是消化性溃疡的主要病因\u2026十二指肠球部溃疡患者Hp感染率高达90％～100％（C错），胃溃疡为80％～90％\u201d（B错）。\r\n[解析]幽门螺杆菌感染与某些疾病的发病常有明显的关系，如胃炎、胃溃疡、十二指肠溃疡和胃癌等，而胃食管反流病是由于机体抗反流防御机制减弱和反流物对食管黏膜攻击作用的结果，因此与幽门螺杆菌感染无关。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"987","all_num":"1073","types":0,"pname":"内科学"},{"id":"204","name":"下列对诊断肝硬化门脉高压症最有价值的体征是：","data":{"A":"蜘蛛痣","B":"脾肿大","C":"肝质地坚硬","D":"腹壁静脉曲张\t"},"da_an":"D","typeid":"117","time":"2005-07-01 15:22:54","xiang_jie":"[答案]D\r\n[考点]肝硬化门脉高压症的体征\r\n[考点还原]（P421）\u201c1.肝功能减退  蜘蛛痣（A错）及肝掌的出现均与雌激素增多有关\u201d。\r\n[解析]门脉高压症是肝硬化失代偿期最重要的临床表现，肝硬化门脉高压症的体征包括腹壁静脉曲张（门-体侧支循环开放）、脾大、腹水征等，但脾大、腹水征也可以见于肝硬化门脉高压症以外的其他原因，所以对诊断肝硬化门脉高压症最有价值的体征是腹壁静脉曲张。而蜘蛛痣和肝质地坚硬均不属于肝硬化门脉高压症的体征。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"963","all_num":"1041","types":0,"pname":"内科学"},{"id":"208","name":"男性，23岁。间断上腹痛2年，2天来柏油样便6次，今晨呕咖啡样物200ml。无肝病史。静脉输液后下一步诊治措施首选：","data":{"A":"急诊胃镜及镜下止血","B":"急诊上消化道造影","C":"腹部B型超声检查","D":"外科手术"},"da_an":"A","typeid":"117","time":"2005-07-01 15:23:56","xiang_jie":"[答案]A\r\n[考点]消化性溃疡出血的处理\r\n[考点还原]（P452）\u201c（一）呕血和黑粪  是上消化道出血的特征性表现。上消化道大量出血之后，均有黑粪。出血部位在幽门以上者常伴呕血\u2026呕血多棕褐色呈咖啡渣样\u201d（P454）\u201c胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（A对）。\r\n[解析]该青年男性患者有长期慢性上腹痛病史，现有出血（呕血和柏油样便），无肝病史，最可能是属于消化性溃疡出血。静脉输液纠正血容量不足后，下一步诊治措施首选急诊胃镜及镜下止血，既可以明确诊断，又可以治疗出血。而正在活动性出血的情况下不宜行上消化道造影；腹部B型超声检查对诊断和止血治疗均无帮助；在未充分内科保守治疗和诊断尚不太明确的情况下也不宜首选外科手术。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1011","all_num":"1038","types":0,"pname":"内科学"},{"id":"213","name":"男性，50岁。胃溃疡病史10年，近2个月腹痛加重，失去规律，经多种药物治疗无效，体重下降。查体：浅表淋巴结无肿大，腹平软，上腹部有压痛。 就目前资料考虑，最可能的诊断是：","data":{"A":"胃溃疡复发","B":"胃溃疡癌变","C":"合并胃泌素瘤","D":"复合性溃疡"},"da_an":"B","typeid":"117","time":"2005-07-01 15:25:39","xiang_jie":"[答案]B\t\r\n[考点]胃溃疡癌变的诊断和治疗\r\n[考点还原]（十四版实用内科学P1918）\u201c癌变  对中年以上、有长期GU病史、顽固不愈、近来疼痛节律性消失、食欲缺乏、体重明显减轻和粪便隐血试验持续阳性的患者，应在内镜检查中多取活检，除外癌变\u201d（B对）。（P376）\u201c胃镜检查结合黏膜活检，是目前最可靠的诊断手段\u201d（D对）。（P374）\u201c（五）外科手术\u2026但在下列情况时，可考虑手术治疗\u2026瘢痕性幽门梗阻；④胃溃疡疑有癌变\u201d（D对）。\r\n[解析]该中年男性患者有长期慢性胃溃疡病史，近来腹痛加重，失去规律，经多种药物治疗无效，体重下降，最可能的诊断是胃溃疡癌变，其他诊断均不像。为明确诊断，最有意义的检查是胃镜检查，既可以观察胃部病变情况，又可以取病理活检。因为诊断是胃溃疡癌变，所以最佳的处理方法是手术治疗，而胃黏膜保护剂、质子泵抑制剂和根除幽门螺杆菌治疗只是针对胃溃疡复发或复合性溃疡的治疗。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"999","all_num":"1050","types":0,"pname":"内科学"},{"id":"217","name":"男性，50岁。胃溃疡病史10年，近2个月腹痛加重，失去规律，经多种药物治疗无效，体重下降。查体：浅表淋巴结无肿大，腹平软，上腹部有压痛。为明确诊断，最有意义的检查是：","data":{"A":"粪隐血试验","B":"血清胃泌素测定","C":"钡餐造影","D":"胃镜检查"},"da_an":"D","typeid":"117","time":"2005-07-01 15:27:04","xiang_jie":"[答案]D\t\r\n[考点]胃溃疡癌变的诊断和治疗\r\n[考点还原]（十四版实用内科学P1918）\u201c癌变  对中年以上、有长期GU病史、顽固不愈、近来疼痛节律性消失、食欲缺乏、体重明显减轻和粪便隐血试验持续阳性的患者，应在内镜检查中多取活检，除外癌变\u201d（B对）。（P376）\u201c胃镜检查结合黏膜活检，是目前最可靠的诊断手段\u201d（D对）。（P374）\u201c（五）外科手术\u2026但在下列情况时，可考虑手术治疗\u2026瘢痕性幽门梗阻；④胃溃疡疑有癌变\u201d（D对）。\r\n[解析]该中年男性患者有长期慢性胃溃疡病史，近来腹痛加重，失去规律，经多种药物治疗无效，体重下降，最可能的诊断是胃溃疡癌变，其他诊断均不像。为明确诊断，最有意义的检查是胃镜检查，既可以观察胃部病变情况，又可以取病理活检。因为诊断是胃溃疡癌变，所以最佳的处理方法是手术治疗，而胃黏膜保护剂、质子泵抑制剂和根除幽门螺杆菌治疗只是针对胃溃疡复发或复合性溃疡的治疗。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1035","all_num":"1060","types":0,"pname":"内科学"},{"id":"221","name":"男性，50岁。胃溃疡病史10年，近2个月腹痛加重，失去规律，经多种药物治疗无效，体重下降。查体：浅表淋巴结无肿大，腹平软，上腹部有压痛。根据诊断，最佳的处理方法是：","data":{"A":"胃黏膜保护剂治疗","B":"质子泵抑制剂治疗","C":"根除幽门螺杆菌","D":"手术治疗"},"da_an":"D","typeid":"117","time":"2005-07-01 15:28:31","xiang_jie":"[答案]D\r\n[考点]胃溃疡癌变的诊断和治疗\r\n[考点还原]（十四版实用内科学P1918）\u201c癌变  对中年以上、有长期GU病史、顽固不愈、近来疼痛节律性消失、食欲缺乏、体重明显减轻和粪便隐血试验持续阳性的患者，应在内镜检查中多取活检，除外癌变\u201d（B对）。（P376）\u201c胃镜检查结合黏膜活检，是目前最可靠的诊断手段\u201d（D对）。（P374）\u201c（五）外科手术\u2026但在下列情况时，可考虑手术治疗\u2026瘢痕性幽门梗阻；④胃溃疡疑有癌变\u201d（D对）。\r\n[解析]该中年男性患者有长期慢性胃溃疡病史，近来腹痛加重，失去规律，经多种药物治疗无效，体重下降，最可能的诊断是胃溃疡癌变，其他诊断均不像。为明确诊断，最有意义的检查是胃镜检查，既可以观察胃部病变情况，又可以取病理活检。因为诊断是胃溃疡癌变，所以最佳的处理方法是手术治疗，而胃黏膜保护剂、质子泵抑制剂和根除幽门螺杆菌治疗只是针对胃溃疡复发或复合性溃疡的治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"1005","all_num":"1068","types":0,"pname":"内科学"},{"id":"224","name":"正在用PPI治疗的溃疡病患者，用下列方法检查幽门螺杆菌（HP）感染时，最不易出现假阴性的是：","data":{"A":"13C尿素呼气试验","B":"快速尿素酶试验","C":"血清学Hp抗体检查","D":"Hp培养"},"da_an":"C","typeid":"117","time":"2018-10-30 17:32:54","xiang_jie":"[答案]C\r\n[考点]幽门螺杆菌（Hp）的检查方法\r\n[考点还原]（七版内科学P390）\u201c（三）幽门螺杆菌检测\u2026检测方法分为侵入性和非侵入性两大类，前者需通过胃镜检查取胃黏膜活组织进行检测，主要包括快速尿素酶试验、组织学检查和幽门螺杆菌培养；后者主要有¹³C或¹\u2074C尿素呼气试验、粪便幽门螺杆菌抗原检测及血清学检查（定性检测血清抗幽门螺杆菌IgG抗体）\u201d。（七版内科学P391）\u201c应注意，近期使用抗生素、质子泵抑制剂、铋剂等药物，因有暂时抑制幽门螺杆菌作用，会使上述检查（血清学检查除外）呈假阴性\u201d（C对）。\r\n[解析]13C尿素呼气试验、快速尿素酶试验、血清学Hp抗体检查和Hp培养等均为检查有无Hp感染的常用方法。正在用PPI治疗的溃疡病患者，因可能有暂时抑制Hp的作用，从而使直接检查Hp的方法可能会出现假阴性结果，而只有检查Hp抗体的方法不受影响。13C尿素呼气试验、快速尿素酶试验和Hp培养均为直接检查Hp的方法，所以只有血清学Hp抗体检查的方法最不易出现假阴性。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"798","all_num":"1062","types":0,"pname":"内科学"},{"id":"231","name":"急性有机磷中毒的下列临床表现中，能提示中度中毒的是：","data":{"A":"出汗、流涎","B":"呕吐、腹泻","C":"胸背部肌肉颤动","D":"瞳孔缩小"},"da_an":"C","typeid":"117","time":"2005-07-01 15:31:05","xiang_jie":"[答案]C\r\n[考点]急性有机磷中毒的分级\r\n[考点还原]（P886）\u201c（三）急性中毒诊断分级  1.轻度中毒  仅有M样症状（ABD错），ChE活力70％～50％。2.中度中毒  M样症状加重，出现N样症状（C对），ChE活力50％～30％。3.重度中毒  具有M、N样症状，并伴有肺水肿、抽搐、昏迷，呼吸肌麻痹和脑水肿，ChE活力30％以下\u201d。\r\n[解析]急性有机磷中毒是按照临床表现和血胆碱酯酶活力测定结果进行分级。仅有M样症状（如出汗、流涎、呕吐、腹泻和瞳孔缩小等），血胆碱酯酶活力70%〜50%为轻度中毒；M样症状加重，出现N样症状（如胸背部肌肉颤动），血胆碱酯酶活力50%〜30%为中度中毒；具有M样和N样症状，并伴有肺水肿、抽搐、昏迷、呼吸肌麻痹和脑水肿，血胆碱酯酶活力30%以下为重度中毒。因此急性有机磷中毒的临床表现中，能提示中度中毒的是胸背部肌肉颤动。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"765","all_num":"954","types":0,"pname":"内科学"},{"id":"234","name":"男性，58岁。黑便3天，呕血1天伴头晕、心悸被送入急诊室。既往有\u201c慢性胃病史\u201d，无肝病史。查体：T 36.6℃，P 96次/分，BP 108/70mmHg，意识清楚，面色苍白，巩膜无黄染，心、肺检查未见异常，腹软，未见腹壁静脉曲张，肝、脾肋下未触及，移动性浊音阴性，肠鸣音活跃。化验Hb 85g/L,WBC 4.0×109/L，Plt 122×109/L。此时最重要的处理原则是：","data":{"A":"补充血容量","B":"急诊内镜","C":"肌注止血药","D":"急症手术治疗"},"da_an":"B","typeid":"117","time":"2005-07-01 15:32:25","xiang_jie":"[答案]B\r\n[考点]急性上消化道大出血的处理原则\r\n[考点还原]（P452）\u201c（一）呕血和黑粪  是上消化道出血的特征性表现。上消化道大量出血之后，均有黑粪。出血部位在幽门以上者常伴呕血\u201d（P454）\u201c（1）胃镜和结肠镜：是诊断上、下消化道出血病因、部位和出血情况的首选方法，它不仅能直视病变、取活检，对于出血病灶可进行及时准确的止血治疗\u201d（B对）。\r\n[解析]根据该中年男性患者的现病史，肯定为急性上消化道大出血，结合既往有\u201c慢性胃病史\u201d，考虑以胃出血可能性大。急诊内镜一方面可以明确出血的病因，另一方面还可以给予相应的急诊处理。患者目前血流动力学还比较稳定，不急需补充血容量；而肌注止血药的疗效有限；病因未明，而且尚未经过内科的充分治疗，尚无急症手术治疗的指征。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"818","all_num":"1093","types":0,"pname":"内科学"},{"id":"240","name":"男性，46岁。饮酒后出现中上腹部持续性疼痛24小时，呕吐2次，呕吐物为胃内容物，呕吐后腹痛不缓解，急诊入院。查体：T37.8℃,P106次/分，BP90/60mmHg,心、肺检查未见异常，上腹中偏左有压痛、局部反跳痛和肌紧张，肝、脾触诊不满意，移动性浊音阳性，肠鸣音1~2次/分，下肢无水肿。最可能的诊断是：","data":{"A":"急性胆囊炎","B":"轻症急性胰腺炎","C":"重症急性胰腺炎","D":"消化性溃疡穿孔"},"da_an":"C","typeid":"117","time":"2018-11-17 15:34:01","xiang_jie":"[答案]C\t\r\n[考点还原]（P439）\u201c酒精可促进胰液分泌，当胰管流出道不能充分引流大量胰液时，胰管内压升高，引发腺泡细胞损伤\u201d（八版外科学P484-P485）\u201c1.腹痛  常于饱餐和饮酒后突然发作，腹痛剧烈，多位于左上腹，向左肩及左腰背部放射。3.恶心、呕吐  该症状早期即可出现\u2026呕吐物为胃十二指肠内容物，偶可呈咖啡色。呕吐后腹痛不缓解\u201d（P441）\u201c表4-18-1  重症急性胰腺炎的症状、体征及相应的病理生理改变\u201d（C对）。[考点还原]（P441）\u201c胰源性胸、腹水和胰腺假性囊肿中的淀粉酶常明显升高\u201d（B对）。（P441）\u201c血清淀粉酶、脂肪酶的高低与病情程度无确切关联，部分患者的两种胰酶可不升高\u201d（A错）。（P443）\u201c由于吗啡可增加Oddi括约肌压力，胆碱能受体拮抗剂如阿托品可诱发或加重肠麻痹，故均不宜使用\u201d（D对）。\r\n[解析]该中年男性患者饮酒后出现中上腹部持续性疼痛伴呕吐，呕吐后腹痛不缓解，查体上腹中偏左有压痛，最可能的诊断是急性胰腺炎。因查体上腹中偏左有反跳痛和肌紧张，移动性浊音阳性，所以最可能的诊断是重症急性胰腺炎。为明确诊断，最有价值的检查是抽取腹水进行淀粉酶测定，重症急性胰腺炎的特点是腹水淀粉酶明显升高，而血淀粉酶常减低；腹部B型超声检查对诊断有帮助，但不是最有价值的检查；立位腹平片只是对除外消化性溃疡穿孔有帮助。因为该患者入院时诊断尚未完全肯定，所以入院时不宜选用的治疗是皮下注射吗啡类止痛药，否则可能会贻误诊断，影响下一步的处理。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"790","all_num":"1023","types":0,"pname":"内科学"},{"id":"247","name":"男性，46岁。饮酒后出现中上腹部持续性疼痛24小时，呕吐2次，呕吐物为胃内容物，呕吐后腹痛不缓解，急诊入院。查体：T37.8℃,P106次/分，BP90/60mmHg,心、肺检查未见异常，上腹中偏左有压痛、局部反跳痛和肌紧张，肝、脾触诊不满意，移动性浊音阳性，肠鸣音1~2次/分，下肢无水肿。为明确诊断，最有价值的检查是：","data":{"A":"血淀粉酶测定","B":"腹水淀粉酶测定","C":"腹部B型超声检查","D":"立位腹平片"},"da_an":"B","typeid":"117","time":"2018-11-17 15:34:38","xiang_jie":"[答案]B\t\r\n[考点]重症急性胰腺炎的诊断和治疗\r\n[考点还原]（P439）\u201c酒精可促进胰液分泌，当胰管流出道不能充分引流大量胰液时，胰管内压升高，引发腺泡细胞损伤\u201d（八版外科学P484-P485）\u201c1.腹痛  常于饱餐和饮酒后突然发作，腹痛剧烈，多位于左上腹，向左肩及左腰背部放射。3.恶心、呕吐  该症状早期即可出现\u2026呕吐物为胃十二指肠内容物，偶可呈咖啡色。呕吐后腹痛不缓解\u201d（P441）\u201c表4-18-1  重症急性胰腺炎的症状、体征及相应的病理生理改变\u201d（C对）。[考点还原]（P441）\u201c胰源性胸、腹水和胰腺假性囊肿中的淀粉酶常明显升高\u201d（B对）。（P441）\u201c血清淀粉酶、脂肪酶的高低与病情程度无确切关联，部分患者的两种胰酶可不升高\u201d（A错）。（P443）\u201c由于吗啡可增加Oddi括约肌压力，胆碱能受体拮抗剂如阿托品可诱发或加重肠麻痹，故均不宜使用\u201d（D对）。\r\n[解析]该中年男性患者饮酒后出现中上腹部持续性疼痛伴呕吐，呕吐后腹痛不缓解，查体上腹中偏左有压痛，最可能的诊断是急性胰腺炎。因查体上腹中偏左有反跳痛和肌紧张，移动性浊音阳性，所以最可能的诊断是重症急性胰腺炎。为明确诊断，最有价值的检查是抽取腹水进行淀粉酶测定，重症急性胰腺炎的特点是腹水淀粉酶明显升高，而血淀粉酶常减低；腹部B型超声检查对诊断有帮助，但不是最有价值的检查；立位腹平片只是对除外消化性溃疡穿孔有帮助。因为该患者入院时诊断尚未完全肯定，所以入院时不宜选用的治疗是皮下注射吗啡类止痛药，否则可能会贻误诊断，影响下一步的处理。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"694","all_num":"1029","types":0,"pname":"内科学"},{"id":"253","name":"男性，46岁。饮酒后出现中上腹部持续性疼痛24小时，呕吐2次，呕吐物为胃内容物，呕吐后腹痛不缓解，急诊入院。查体：T37.8℃,P106次/分，BP90/60mmHg,心、肺检查未见异常，上腹中偏左有压痛、局部反跳痛和肌紧张，肝、脾触诊不满意，移动性浊音阳性，肠鸣音1?2次/分，下肢无水肿。该患者入院时最不宜选用的治疗是：","data":{"A":"禁食、补液","B":"静脉给予抑制胃酸分泌药","C":"静脉给予抗生素","D":"皮下注射吗啡类止痛药"},"da_an":"D","typeid":"117","time":"2018-11-17 15:36:00","xiang_jie":"[答案]D\r\n[解析]该中年男性患者饮酒后出现中上腹部持续性疼痛伴呕吐，呕吐后腹痛不缓解，查体上腹中偏左有压痛，最可能的诊断是急性胰腺炎。因查体上腹中偏左有反跳痛和肌紧张，移动性浊音阳性，所以最可能的诊断是重症急性胰腺炎。为明确诊断，最有价值的检查是抽取腹水进行淀粉酶测定，重症急性胰腺炎的特点是腹水淀粉酶明显升高，而血淀粉酶常减低；腹部B型超声检查对诊断有帮助，但不是最有价值的检查；立位腹平片只是对除外消化性溃疡穿孔有帮助。因为该患者入院时诊断尚未完全肯定，所以入院时不宜选用的治疗是皮下注射吗啡类止痛药，否则可能会贻误诊断，影响下一步的处理。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"885","all_num":"951","types":0,"pname":"内科学"},{"id":"259","name":"下列关于胃食管反流病胸痛的叙述，错误的是：","data":{"A":"反流物刺激食管痉挛所致","B":"疼痛可发生在胸骨后","C":"疼痛不向他处放射","D":"疼痛可为剧烈刺痛"},"da_an":"C","typeid":"117","time":"2005-07-01 15:38:28","xiang_jie":"[答案]C\r\n[考点]胃食管反流病的临床表现特点\r\n[考点还原]（P357）\u201c胸痛由反流物刺激食管引起（A对），发生在胸骨后（B对）。严重时可为剧烈刺痛（D对），可放射到后背、胸部、肩部、颈部、耳后（C错，为本题正确答案）\u201d。\r\n[解析]胃食管反流病是指胃十二指肠内容物反流入食管引起的一系列症状。其中胸痛是该病的非典型症状，是由反流物刺激食管痉挛所致，疼痛可发生在胸骨后，疼痛可为剧烈刺痛，疼痛可放射到后背、胸部、肩部、颈部、耳后等部位，有时酷似心绞痛。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"888","all_num":"976","types":0,"pname":"内科学"},{"id":"264","name":"下列属于肝硬化肝肾综合征诊断标准的是：","data":{"A":"肝硬化不合并腹水","B":"有休克","C":"近期未使用肾毒性药物","D":"血肌酐大于123μmol/L"},"da_an":"C","typeid":"117","time":"2005-07-01 15:39:36","xiang_jie":"[答案]C\r\n[考点]肝硬化肝肾综合征的诊断标准\r\n[考点还原]（P424）\u201c（六）肝肾综合征\u2026肝肾综合征的诊断标准：①肝硬化合并腹水（A错）；②急进型血清肌酐浓度在2周内升至2倍基线值，或＞226μmol/L（25mg/L），缓进型血清肌酐＞133μmol/L（15mg/L）（D错）；③停利尿剂至少2天以上并经白蛋白扩容后，血肌酐值没有改善。④排除休克（B错）；⑤目前或近期没有用肾毒性药物或扩血管药物治疗（C对）；⑥排除肾实质性疾病\u201d。\r\n[解析]美国肝病学会于2007年推荐发生在肝硬化基础上肝肾综合征诊断的标准是：①肝硬化合并腹水；②无休克；③血肌酐大于133μmol/L；④近期未使用肾毒性药物等。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"732","all_num":"931","types":0,"pname":"内科学"},{"id":"268","name":"患者，男，40岁。8小时前开始上腹剧烈疼痛。查体：上腹部有压痛。此时对确诊价值不大的检查是：","data":{"A":"血淀粉酶","B":"尿淀粉酶","C":"心电图","D":"X线腹部平片"},"da_an":"B","typeid":"117","time":"2005-07-01 15:40:42","xiang_jie":"[答案]B\r\n[考点]急性胰腺炎的诊断\r\n[考点还原]（七版内科学P472）\u201c尿淀粉酶（B对）升高较晚，在发病后12～72小时开始升高，持续7～10天，对病后就诊较晚的急性胰腺炎患者有诊断价值，且特异性也较高\u201d。\r\n[解析]根据该中年男性的病史，首先考虑为急性胰腺炎，血淀粉酶在起病后6〜12小时开始上升，48小时开始下降，所以检查血淀粉酶有确诊价值。为除外急性心肌梗死和急腹症，心电图和X线腹部平片检查也很有意义。而在急性胰腺炎时，尿淀粉酶在起病后12〜14小时才开始上升，而该患者刚起病8小时，所以检查尿淀粉酶的确诊价值不大。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"710","all_num":"998","types":0,"pname":"内科学"},{"id":"275","name":"患者，男，35岁。3个月来间断上腹痛，有时夜间痛醒，反酸。1天前黑便1次，无呕血，但腹痛减轻，化验大便隐血强阳性。最可能的诊断是：","data":{"A":"慢性胃炎","B":"胃溃疡","C":"十二指肠溃疡","D":"胃癌"},"da_an":"C","typeid":"117","time":"2005-07-01 15:42:15","xiang_jie":"[答案]C\t\r\n[考点]十二指肠溃疡的诊断\r\n[考点还原]（P371）\u201c消化性溃疡是上消化道出血中最常见的病因，约占所有病因的50％，十二指肠球部溃疡较胃溃疡易发生\u2026轻者表现为黑粪，重者出现呕血。有慢性腹痛者，出血后腹痛可减轻\u201d（C对）。（七版内科学P389）\u201c发作时上腹痛呈节律性，表现为空腹痛即餐后2～4小时或（及）午夜痛，腹痛多为进食或服用抗酸药所缓解，典型节律性表现在DU多见\u201d。（P371）\u201c（一）胃镜及黏膜活检  胃镜是消化性溃疡诊断的首选方法\u201d（A对）。P453）\u201c成人每日消化道出血＞5ml，粪便潜血试验即出现阳性；每日出血量超过50ml可出现黑粪；胃内积血量＞250ml可引起呕血\u201d（B对）。\r\n[解析]该男性的病史中，呈间断上腹痛，夜间痛醒伴反酸，而且于出血后腹痛减轻，均提示为典型的十二指肠溃疡；为了确定诊断，首选的检查是胃镜检查，可给予直接确诊依据。而其他检查方法均不能给予直接的确诊依据。若患者出现黑便，每日出血量最少应超过50ml。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"874","all_num":"925","types":0,"pname":"内科学"},{"id":"281","name":"患者，男，35岁。3个月来间断上腹痛，有时夜间痛醒，反酸。1天前黑便1次，无呕血，但腹痛减轻，化验大便隐血强阳性。为了确定诊断，首选的检查是：","data":{"A":"胃镜检查","B":"钡餐透视","C":"腹部CT","D":"腹部B超"},"da_an":"A","typeid":"117","time":"2005-07-01 15:43:39","xiang_jie":"[答案]A\t\r\n[考点]十二指肠溃疡的诊断\r\n[考点还原]（P371）\u201c消化性溃疡是上消化道出血中最常见的病因，约占所有病因的50％，十二指肠球部溃疡较胃溃疡易发生\u2026轻者表现为黑粪，重者出现呕血。有慢性腹痛者，出血后腹痛可减轻\u201d（C对）。（七版内科学P389）\u201c发作时上腹痛呈节律性，表现为空腹痛即餐后2～4小时或（及）午夜痛，腹痛多为进食或服用抗酸药所缓解，典型节律性表现在DU多见\u201d。（P371）\u201c（一）胃镜及黏膜活检  胃镜是消化性溃疡诊断的首选方法\u201d（A对）。P453）\u201c成人每日消化道出血＞5ml，粪便潜血试验即出现阳性；每日出血量超过50ml可出现黑粪；胃内积血量＞250ml可引起呕血\u201d（B对）。\r\n[解析]该男性的病史中，呈间断上腹痛，夜间痛醒伴反酸，而且于出血后腹痛减轻，均提示为典型的十二指肠溃疡；为了确定诊断，首选的检查是胃镜检查，可给予直接确诊依据。而其他检查方法均不能给予直接的确诊依据。若患者出现黑便，每日出血量最少应超过50ml。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"883","all_num":"897","types":0,"pname":"内科学"},{"id":"285","name":"患者，男，35岁。3个月来间断上腹痛，有时夜间痛醒，反酸。1天前黑便1次，无呕血，但腹痛减轻，化验大便隐血强阳性。若患者出现黑便，每日出血量最少应超过：","data":{"A":"30ml","B":"50ml","C":"150ml","D":"300ml"},"da_an":"B","typeid":"117","time":"2005-07-01 15:44:53","xiang_jie":"[答案]B\r\n[考点]十二指肠溃疡的诊断\r\n[考点还原]（P371）\u201c消化性溃疡是上消化道出血中最常见的病因，约占所有病因的50％，十二指肠球部溃疡较胃溃疡易发生\u2026轻者表现为黑粪，重者出现呕血。有慢性腹痛者，出血后腹痛可减轻\u201d（C对）。（七版内科学P389）\u201c发作时上腹痛呈节律性，表现为空腹痛即餐后2～4小时或（及）午夜痛，腹痛多为进食或服用抗酸药所缓解，典型节律性表现在DU多见\u201d。（P371）\u201c（一）胃镜及黏膜活检  胃镜是消化性溃疡诊断的首选方法\u201d（A对）。P453）\u201c成人每日消化道出血＞5ml，粪便潜血试验即出现阳性；每日出血量超过50ml可出现黑粪；胃内积血量＞250ml可引起呕血\u201d（B对）。\r\n[解析]该男性的病史中，呈间断上腹痛，夜间痛醒伴反酸，而且于出血后腹痛减轻，均提示为典型的十二指肠溃疡；为了确定诊断，首选的检查是胃镜检查，可给予直接确诊依据。而其他检查方法均不能给予直接的确诊依据。若患者出现黑便，每日出血量最少应超过50ml。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"849","all_num":"897","types":0,"pname":"内科学"},{"id":"290","name":"预防非甾体抗炎药所致消化性溃疡的首选药物是：","data":{"A":"硫糖铝","B":"胶体铋","C":"米索前列醇","D":"阿莫西林"},"da_an":"C","typeid":"117","time":"2005-07-01 15:46:05","xiang_jie":"[答案]C\r\n[考点]消化性溃疡的预防\r\n    [考点还原]（七版内科学P393）\u201c2.保护胃黏膜药物\u2026米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用，主要用于NSAID溃疡的预防\u201d（C对）。\r\n[解析]非甾体抗炎药是致消化性溃疡的重要原因之一，通过抑制环氧化酶（COX）导致胃肠黏膜生理性前列腺素E合成不足，促进胃酸分泌引起消化性溃疡。米索前列醇是临床合成的前列腺素E的衍生物，故有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用，主要用于预防非甾体抗炎药所致消化性溃疡。因此答案是C。而硫糖铝和胶体铋虽然也是保护胃黏膜药物，但目前已较少使用，阿莫西林是抗生素，不用于预防非甾体抗炎药所致消化性溃疡。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"775","all_num":"904","types":0,"pname":"内科学"},{"id":"295","name":"下列关于肝肾综合征临床特点的叙述中，错误的是：","data":{"A":"自发性少尿或无尿","B":"血肌酐升高","C":"血钠升高","D":"尿钠降低"},"da_an":"C","typeid":"117","time":"2005-07-01 15:47:09","xiang_jie":"[答案]C\r\n[考点]肝肾综合征的临床表现\r\n[考点还原]（七版内科学P450）\u201c肝肾综合征 \u2026HRS临床表现为自发性少尿或无尿（A对），氮质血症和血肌酐升高（B对），稀释性低钠血症（C错，为本题正确答案），低尿钠（D对）\u201d。\r\n[解析]肝肾综合征是在严重肝病基础上发生的肾衰竭。发病机制主要是全身血流动力学的改变，使肾小球滤过率下降，所以其临床表现是自发性少尿或无尿、血肌酐升高、稀释性低血钠和尿钠降低。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"831","all_num":"888","types":0,"pname":"内科学"},{"id":"300","name":"女性，32岁，反复发作腹泻3年，伴便前腹痛，便后缓解，体重无变化。近3个月来由于变换工作不顺利等原因，上述症状加重，每日大便5~6次，有黏液，无脓血，使用抗生素治疗效果欠佳。最可能的诊断是：","data":{"A":"肠易激综合征","B":"感染性腹泻","C":"炎症性肠病","D":"抗生素相关性腹泻"},"da_an":"A","typeid":"117","time":"2018-09-12 18:23:23","xiang_jie":"[答案]A\r\n\r\n[考点]肠易激综合征的诊断\r\n\r\n[考点还原]（P400）\u201c【临床表现】 起病隐匿，症状反复发作或慢性迁延，病程可长达数年至数十年，但全身健康状况却不受影响。精神、饮食等因素常诱使症状复发或加重。最主要的临床表现是腹痛或腹部不适、排便习惯和粪便性状的改变\u2026几乎所有的IBS患者均有不同程度的腹痛或腹部不适，部位不定，以下腹和左下腹多见，排便或排气后缓解\u2026腹泻型IBS常排便较急，粪便呈糊状或稀水样，一般每日3～5次左右，少数严重发作期可达十余次，可带有黏液，但无脓血\u201d（A对）。\r\n\r\n[解析]该中年女性","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"867","all_num":"880","types":0,"pname":"内科学"},{"id":"303","name":"男性，55岁，2天前酒后出现上腹痛，进行性加重，并向腰背部放散，曾呕吐1次，为胃内容物，呕吐后腹痛未减轻，稀便2次。既往有\u201c胆石症\u201d病史10年，无高血压、糖尿病病史。查体：体温37.3℃，脉搏80次/分，呼吸20次/分，血压120/80mmHg，巩膜无黄染，心肺未见异常，腹平软，上腹部轻压痛，肝脾肋下未触及。对该患者最可能的诊断是：","data":{"A":"急性胃肠炎","B":"急性胆囊炎","C":"十二指肠球后溃疡","D":"急性胰腺炎"},"da_an":"D","typeid":"117","time":"2005-07-01 15:49:47","xiang_jie":"[考点还原]（P439）\u201c（一）胆道疾病  胆石症及胆道感染等是急性胰腺炎的主要病因\u2026（二）酒精\u2026应注意酒精常与胆道疾病共同导致急性胰腺炎\u201d（八版外科学P484-P485）\u201c1.腹痛  常于饱餐和饮酒后突然发作，腹痛剧烈，多位于左上腹，向左肩及左腰背部放射\u20263.恶心、呕吐  该症状早期即可出现\u2026呕吐物为胃十二指肠内容物，偶可呈咖啡色。呕吐后腹痛不缓解\u201d（D对）。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"817","all_num":"872","types":0,"pname":"内科学"},{"id":"311","name":"男性，55岁，2天前酒后出现上腹痛，进行性加重，并向腰背部放散，曾呕吐1次，为胃内容物，呕吐后腹痛未减轻，稀便2次。既往有\u201c胆石症\u201d病史10年，无高血压、糖尿病病史。查体：体温37.3℃，脉搏80次/分，呼吸20次/分，血压120/80mmHg，巩膜无黄染，心肺未见异常，腹平软，上腹部轻压痛，肝脾肋下未触及。为明确诊断，应首先进行的检查是：","data":{"A":"血、尿淀粉酶","B":"便常规和隐血","C":"腹部CT","D":"胃镜"},"da_an":"A","typeid":"117","time":"2005-07-01 15:52:18","xiang_jie":"[考点还原]（P441）\u201c（一）诊断急性胰腺炎的重要标志物  1.淀粉酶  急性胰腺炎时，血清淀粉酶于起病后2～12小时开始升高，48小时开始下降，持续3～5天\u20262.脂肪酶\u201d（A对）。[答案]A\t\r\n[考点]急性胰腺炎的诊断和治疗\r\n[解析]该中年男性患者酒后急性上腹痛，进行性加重，向腰背部放散，呕吐后腹痛未减轻，既往有\u201c胆石症\u201d病史，上腹有压痛等，为典型的急性胰腺炎的临床表现。急性胃肠炎、急性胆囊炎和十二指肠球后溃疡虽然均有上腹痛，但都不像；发病2天的急性胰腺炎，为明确诊断，应首先进行的检查是血、尿淀粉酶测定，因为血清淀粉酶在起病6〜12小时开始升高，48小时开始下降，持续3〜5天，尿淀粉酶在起病12〜14小时开始升高，持续1〜2周；急性胰腺炎最基本的治疗是禁食补液，以减少胰腺的分泌，该患者最可能是急性水肿型胰腺炎，禁食补液更是最基本的治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"794","all_num":"873","types":0,"pname":"内科学"},{"id":"316","name":"男性，55岁，2天前酒后出现上腹痛，进行性加重，并向腰背部放散，曾呕吐1次，为胃内容物，呕吐后腹痛未减轻，稀便2次。既往有\u201c胆石症\u201d病史10年，无高血压、糖尿病病史。查体：体温37.3℃，脉搏80次/分，呼吸20次/分，血压120/80mmHg，巩膜无黄染，心肺未见异常，腹平软，上腹部轻压痛，肝脾肋下未触及。对该患者最基本的治疗是：","data":{"A":"解痉止痛","B":"禁食补液","C":"抑制胃酸","D":"静脉注射抗生素"},"da_an":"B","typeid":"117","time":"2005-07-01 15:53:57","xiang_jie":"[考点还原]（P443）\u201c1.液体复苏  旨在迅速纠正组织缺氧，也是维持血容量及水、电解质平衡的重要措施\u201d（P443）\u201c（三）减少胰液分泌  1.禁食  食物是胰液分泌的天然刺激物，起病后短期禁食，降低胰液分泌，减轻自身消化\u201d（B对）。[答案]B\r\n[考点]急性胰腺炎的诊断和治疗\r\n[解析]该中年男性患者酒后急性上腹痛，进行性加重，向腰背部放散，呕吐后腹痛未减轻，既往有\u201c胆石症\u201d病史，上腹有压痛等，为典型的急性胰腺炎的临床表现。急性胃肠炎、急性胆囊炎和十二指肠球后溃疡虽然均有上腹痛，但都不像；发病2天的急性胰腺炎，为明确诊断，应首先进行的检查是血、尿淀粉酶测定，因为血清淀粉酶在起病6〜12小时开始升高，48小时开始下降，持续3〜5天，尿淀粉酶在起病12〜14小时开始升高，持续1〜2周；急性胰腺炎最基本的治疗是禁食补液，以减少胰腺的分泌，该患者最可能是急性水肿型胰腺炎，禁食补液更是最基本的治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"796","all_num":"853","types":0,"pname":"内科学"},{"id":"322","name":"引起肠易激综合征发病的最重要因素是：","data":{"A":"急性肠道感染","B":"精神心理障碍","C":"内脏感知异常","D":"对某些食物不耐受"},"da_an":"B","typeid":"117","time":"2005-07-01 15:55:14","xiang_jie":"[答案]B\r\n[考点]肠易激综合征的病因\r\n[考点还原]（P399）\u201c【病因和发病机制】\u2026⑤精神心理障碍：大量调查表明，IBS患者焦虑、抑郁积分显著高于正常人，应激事件发生频率亦高于正常人，对应激反应更敏感和强烈\u201d（B对）。\r\n[解析]肠易激综合征（IBS）是一种功能性肠病。IBS的病因和发病机制尚不清楚，可能与多种因素有关，题中的四个选项均为IBS的发病因素，但只有精神心理障碍是最重要的因素，因为IBS患者存在个性异常，焦虑、抑郁积分显著高于正常人，应激事件发生频率亦高于正常人，所以答案是B。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"839","all_num":"860","types":0,"pname":"内科学"},{"id":"326","name":"下列关于溃疡性结肠炎的肠外表现中，随肠炎控制或结肠切除后可以缓解或恢复的是：","data":{"A":"淀粉样变性","B":"强直性脊柱炎","C":"外周关节炎","D":"骶髂关节炎"},"da_an":"C","typeid":"117","time":"2005-07-01 15:56:19","xiang_jie":"[答案]C\r\n[考点]溃疡性结肠炎的临床表现\r\n[考点还原]（P386）\u201c（三）肠外表现  包括外周关节炎（C对）、结节性红斑、坏疽性脓皮病、巩膜外层炎、前葡萄膜炎、口腔复发性溃疡等，这些肠外表现在结肠炎控制或结肠切除后可以缓解或恢复；骶髂关节炎（D错）、强直性脊柱炎（B错）、原发性硬化性胆管炎及少见的淀粉样变性（A错）、急性发热性嗜中性皮肤病等，可与UC共存，但与UC本身的病情变化无关\u201d。\r\n[解析]溃疡性结肠炎的肠外表现分为两类，一类是随肠炎控制或结肠切除后可以缓解或恢复的，如外周关节炎、结节性红斑、坏死性脓皮病、前葡萄膜炎、巩膜外层炎、口腔复发性溃疡等；另一类是与溃疡性结肠炎共存，但与溃疡性结肠炎本身的病情变化无关，如淀粉样变性、强直性脊柱炎、骶髂关节炎、原发性硬化性胆管炎等。所以随肠炎控制或结肠切除后可以缓解或恢复的是外周关节炎。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"761","all_num":"870","types":0,"pname":"内科学"},{"id":"330","name":"患者，男，54岁。患肝炎后肝硬化10年，近1周来病情加重，腹水量增加，腹胀明显，并出现呼吸困难、睡眠障碍和意识错乱。为减少腹水，下列最佳的治疗药物是：","data":{"A":"阿米洛利","B":"氢氯噻嗪","C":"螺内酯","D":"呋塞米"},"da_an":"C","typeid":"117","time":"2005-07-01 15:57:23","xiang_jie":"[答案]C\r\n[考点]肝硬化腹水的治疗\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]该中年患者患肝炎后肝硬化伴大量腹水，目前已有肝性脑病和因大量腹水引起的呼吸困难的表现。肝硬化腹水的形成与激活肾素-血管紧张素-醛固酮系统有关，螺内酯可通过拮抗醛固酮而发挥利尿作用，而且作用缓和，短期应用不易产生水、电解质紊乱，而其他三种利尿药物作用机制不同，利尿作用强，易引起水、电解质紊乱，并有导致肝性脑病和肝肾综合征的危险。所以最佳的治疗药物是螺内酯。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"738","all_num":"875","types":0,"pname":"内科学"},{"id":"337","name":"患者，女，45岁。反复发作脓血便十余年，此期间有时伴膝关节疼痛，多次大便细菌培养阴性，X线钡剂检查见乙状结肠袋消失，肠壁变硬，肠管变细。 最可能的诊断是：","data":{"A":"溃疡性结肠炎","B":"克罗恩病","C":"肠结核","D":"慢性细菌性痢疾"},"da_an":"A","typeid":"117","time":"2005-07-01 15:59:17","xiang_jie":"[考点还原]（P386）\u201c（一）消化系统表现  1.腹泻和黏液脓血便  见于绝大多数患者\u201d（P386）\u201c（三）肠外表现  包括外周关节炎\u2026\u201d（P387）\u201c（五）X线钡剂灌肠\u2026肠管缩短，结肠袋消失，肠壁变硬，可呈铅管状\u201d（A对）[答案]A\t\r\n[考点]溃疡性结肠炎的临床表现、诊断、并发症\r\n[解析]这是一道临床应用题。该例中年女性患者，有多年慢性脓血便史，但多次大便细菌培养阴性，不支持慢性细菌性痢疾。X线钡剂检查示病变在乙状结肠，而克罗恩病和肠结核的病变主要位于回盲部，而非乙状结肠，所以最可能的诊断是溃疡性结肠炎。因为溃疡性结肠炎的病变部位在乙状结肠，所以腹痛的特点应该是腹痛\u2014便意\u2014便后缓解，腹痛与进食一般无关；溃疡性结肠炎有多种并发症，其中最严重的是中毒性巨结肠，多发生在暴发型或重症溃疡性结肠炎，该患者病史已十余年，X线钡剂检查见乙状结肠肠壁已变硬，肠管变细，所以该患者最不可能出现的并发症是中毒性巨结肠。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"827","all_num":"880","types":0,"pname":"内科学"},{"id":"344","name":"患者，女，45岁。反复发作脓血便十余年，此期间有时伴膝关节疼痛，多次大便细菌培养阴性，X线钡剂检查见乙状结肠袋消失，肠壁变硬，肠管变细。该病腹痛的特点是：","data":{"A":"腹痛\u2014进食\u2014缓解","B":"腹痛\u2014进食\u2014加重","C":"腹痛\u2014便意\u2014便后缓解","D":"腹痛\u2014便意\u2014便后无变化"},"da_an":"C","typeid":"117","time":"2005-07-01 16:00:58","xiang_jie":"[考点还原]（P386）\u201c常有里急后重，便后腹痛缓解\u201d（C对）。[答案]C\t\r\n[考点]溃疡性结肠炎的临床表现、诊断、并发症\r\n[解析]这是一道临床应用题。该例中年女性患者，有多年慢性脓血便史，但多次大便细菌培养阴性，不支持慢性细菌性痢疾。X线钡剂检查示病变在乙状结肠，而克罗恩病和肠结核的病变主要位于回盲部，而非乙状结肠，所以最可能的诊断是溃疡性结肠炎。因为溃疡性结肠炎的病变部位在乙状结肠，所以腹痛的特点应该是腹痛\u2014便意\u2014便后缓解，腹痛与进食一般无关；溃疡性结肠炎有多种并发症，其中最严重的是中毒性巨结肠，多发生在暴发型或重症溃疡性结肠炎，该患者病史已十余年，X线钡剂检查见乙状结肠肠壁已变硬，肠管变细，所以该患者最不可能出现的并发症是中毒性巨结肠。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"827","all_num":"873","types":0,"pname":"内科学"},{"id":"348","name":"患者，女，45岁。反复发作脓血便十余年，此期间有时伴膝关节疼痛，多次大便细菌培养阴性，X线钡剂检查见乙状结肠袋消失，肠壁变硬，肠管变细。该患者最不可能出现的并发症是：","data":{"A":"中毒性巨结肠","B":"癌变","C":"肠出血","D":"肠梗阻"},"da_an":"A","typeid":"117","time":"2005-07-01 16:02:26","xiang_jie":"[考点还原]  八版内科学未明确说明。[答案]A\r\n[考点]溃疡性结肠炎的临床表现、诊断、并发症\r\n[解析]这是一道临床应用题。该例中年女性患者，有多年慢性脓血便史，但多次大便细菌培养阴性，不支持慢性细菌性痢疾。X线钡剂检查示病变在乙状结肠，而克罗恩病和肠结核的病变主要位于回盲部，而非乙状结肠，所以最可能的诊断是溃疡性结肠炎。因为溃疡性结肠炎的病变部位在乙状结肠，所以腹痛的特点应该是腹痛\u2014便意\u2014便后缓解，腹痛与进食一般无关；溃疡性结肠炎有多种并发症，其中最严重的是中毒性巨结肠，多发生在暴发型或重症溃疡性结肠炎，该患者病史已十余年，X线钡剂检查见乙状结肠肠壁已变硬，肠管变细，所以该患者最不可能出现的并发症是中毒性巨结肠。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"587","all_num":"905","types":0,"pname":"内科学"},{"id":"352","name":"下列选项中，不支持有活动性消化道出血的临床表现是：","data":{"A":"贫血","B":"肠鸣音减弱","C":"白细胞增高","D":"血尿素氮增高\t"},"da_an":"B","typeid":"117","time":"2005-07-01 16:03:29","xiang_jie":"[答案]B\r\n[考点]活动性消化道出血的临床表现\r\n[考点还原]（P453-P454）\u201c（三）判断出血是否停止  下列情况应考虑有消化道活动出血：①反复呕血或黑粪（血便）次数增多、粪质稀薄，伴有肠鸣音活跃（B对）；②周围循环状态经充分补液及输血后未见明显改善，或虽暂时好转而又继续恶化；③血红蛋白浓度（A错）、红细胞计数与血细胞比容继续下降，网织红细胞计数持续增高；④补液与尿量足够的情况下，血尿素氮持续或再次增高（D错）\u201d。\r\n[解析]有活动性消化道出血时，临床上可出现贫血、肠鸣音活跃、白细胞增高和血尿素氮增高，因此不会出现肠鸣音减弱。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"612","all_num":"885","types":0,"pname":"内科学"},{"id":"359","name":"下列符合中度有机磷中毒时的胆碱酯酶活力是：","data":{"A":"35%","B":"25%","C":"15%","D":"10%"},"da_an":"A","typeid":"117","time":"2005-07-01 16:04:54","xiang_jie":"[答案]A\r\n[考点]有机磷中毒时胆碱酯酶活力检查的临床意义\r\n[考点还原]（P885）\u201c（一）血ChE活力测定\u2026以正常人血ChE活力值作为100％，急性OPI中毒时，ChE活力值在70％～50％为轻度中毒；50％～30％为中度中毒（A对）；30％以下为重度中毒\u201d。\r\n[解析]有机磷中毒时的胆碱酯酶活力变化，对临床判断有机磷中毒的程度很有意义。中度有机磷中毒时的胆碱酯酶活力是50%〜30%,胆碱酯酶活力在30%以下时为重度有机磷中毒，胆碱酯酶活力在50%以上时为轻度有机磷中毒。因此答案是A。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"600","all_num":"764","types":0,"pname":"内科学"},{"id":"363","name":"患者，男，40岁。6小时前大量饮酒后出现持续性上腹疼痛，阵发性加重，向腰背部放射，弯腰抱膝位可减轻。查体：上腹有压痛，轻度肌紧张。最不可能出现的实验室检查结果是：","data":{"A":"血清淀粉酶明显升高","B":"腹水淀粉酶明显升高","C":"血糖升高","D":"血钙降低"},"da_an":"A","typeid":"117","time":"2005-07-01 16:05:54","xiang_jie":"[答案]A\r\n[考点]急性重症胰腺炎的实验室检查\r\n[考点还原]（P440）\u201c（一）轻症急性胰腺炎  急性腹痛，常较剧烈，多位于中左上腹、甚至全腹，部分患者腹痛向背部放射\u2026（二）重症急性胰腺炎  在上述症状基础上，腹痛持续不缓、腹胀加重\u201d（八版外科学P485）\u201c诊断性腹腔穿刺若抽出血性渗出液，其淀粉酶值升高对诊断很有帮助\u201d（P441）\u201c表4-18-2  反映SAP病理生理变化的实验室检测指标\u201d（BCD对）。\r\n[解析]该例中年男性患者，急性起病，持续上腹部疼痛，阵发性加重，向腰背部放射，弯腰抱膝位可减轻，是典型的急性胰腺炎的临床表现，查体发现上腹有压痛和轻度肌紧张，提示为急性重症胰腺炎。一般急性重症胰腺炎时血清淀粉酶常升高不明显，有时甚至降低，而腹水淀粉酶明显升高、血糖升高和血钙降低常是急性重症胰腺炎的实验室检查结果。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"469","all_num":"860","types":0,"pname":"内科学"},{"id":"380","name":"患者，男，45岁。2个月来反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，近1周来加重，有时伴胸骨后疼痛，ECG未见明显异常，内镜检查见食管黏膜破损有融合。对该患者的诊断是：","data":{"A":"胃食管反流病","B":"心绞痛","C":"Mallory-Weiss综合征","D":"食管憩室炎"},"da_an":"A","typeid":"117","time":"2005-07-01 16:11:07","xiang_jie":"[考点还原]（P357）\u201c烧心和反流是本病最常见和典型的症状\u2026烧心和反流常在餐后1小时出现，卧位、弯腰或腹压增高时可加重\u201d（P357）\u201c2.非典型症状  胸痛由反流物刺激食管引起，发生在胸骨后\u201d（P358）\u201c胃镜下RE分级\u2026C级：黏膜破损有融合，但小于75％的食管周径；D级：黏膜破损融合，至少达到75％的食管周径\u201d（A对）。[答案]A\t\r\n[考点]胃食管反流病的诊断和治疗\r\n[解析]该中年男性患者的病史有反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，内镜检查结果发现食管黏膜破损有融合，这些均支持胃食管反流病的诊断。有时伴胸骨后疼痛，虽可支持心绞痛的诊断，但心绞痛的疼痛一般与体位无关。该病例的特点均不支持Mallory-Weiss综合征和食管憩室炎的诊断。胃食管反流病的最佳治疗药物是奥美拉唑，这类药物抑酸作用强，特别适用于症状重、有严重食管炎的患者，若需维持治疗，选用的最佳药物是奥美拉唑，因为此药的效果最好。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"811","all_num":"822","types":0,"pname":"内科学"},{"id":"387","name":"患者，男，45岁。2个月来反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，近1周来加重，有时伴胸骨后疼痛，ECG未见明显异常，内镜检查见食管黏膜破损有融合。选用的最佳治疗药物是：","data":{"A":"多潘立酮","B":"硝酸甘油","C":"氢氧化铝","D":"奥美拉唑"},"da_an":"D","typeid":"117","time":"2005-07-01 16:13:04","xiang_jie":"[考点还原]（P359）\u201c2.抑酸药  对初次接受治疗的患者或有食管炎的患者宜以PPI治疗，以求迅速控制症状、治愈食管炎\u201d（P359）\u201c2.抑酸药  对初次接受治疗的患者或有食管炎的患者宜以PPI治疗，以求迅速控制症状、治愈食管炎\u201d（D对）。[答案]D\t\r\n[考点]胃食管反流病的诊断和治疗\r\n[解析]该中年男性患者的病史有反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，内镜检查结果发现食管黏膜破损有融合，这些均支持胃食管反流病的诊断。有时伴胸骨后疼痛，虽可支持心绞痛的诊断，但心绞痛的疼痛一般与体位无关。该病例的特点均不支持Mallory-Weiss综合征和食管憩室炎的诊断。胃食管反流病的最佳治疗药物是奥美拉唑，这类药物抑酸作用强，特别适用于症状重、有严重食管炎的患者，若需维持治疗，选用的最佳药物是奥美拉唑，因为此药的效果最好。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"785","all_num":"800","types":0,"pname":"内科学"},{"id":"394","name":"患者，男，45岁。2个月来反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，近1周来加重，有时伴胸骨后疼痛，ECG未见明显异常，内镜检查见食管黏膜破损有融合。若需维持治疗，选用的最佳药物是：","data":{"A":"雷尼替丁","B":"奥美拉唑","C":"枸橼酸铋钾","D":"莫沙比利"},"da_an":"B","typeid":"117","time":"2005-07-01 16:14:53","xiang_jie":"[考点还原]（P359）\u201cPPI和H\u2082RA均可用于维持治疗，PPI效果更优\u201d（B对）。[答案]B\r\n[考点]胃食管反流病的诊断和治疗\r\n[解析]该中年男性患者的病史有反酸、反食和烧心，多于餐后明显，平卧或身体前倾时易出现，内镜检查结果发现食管黏膜破损有融合，这些均支持胃食管反流病的诊断。有时伴胸骨后疼痛，虽可支持心绞痛的诊断，但心绞痛的疼痛一般与体位无关。该病例的特点均不支持Mallory-Weiss综合征和食管憩室炎的诊断。胃食管反流病的最佳治疗药物是奥美拉唑，这类药物抑酸作用强，特别适用于症状重、有严重食管炎的患者，若需维持治疗，选用的最佳药物是奥美拉唑，因为此药的效果最好。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"768","all_num":"794","types":0,"pname":"内科学"},{"id":"399","name":"结核性腹膜炎腹痛的特点是：","data":{"A":"早期腹痛明显","B":"呈持续性绞痛","C":"疼痛多位于脐周、下腹","D":"呈转移性疼痛\t"},"da_an":"C","typeid":"117","time":"2005-07-01 16:16:01","xiang_jie":"[答案]C\r\n[考点]结核性腹膜炎腹痛的特点\r\n[考点还原]（P382）\u201c（二）腹痛  位于脐周、下腹或全腹，持续或阵发性隐痛\u201d（C对）。（七版内科学P406）\u201c（二）腹痛  早期腹痛不明显（A错），以后可出现持续性隐痛或钝痛（B错），也可始终没有腹痛。疼痛多位于脐周、下腹（C对），有时在全腹。当并发不完全性肠梗阻时，有阵发性绞痛。偶可表现为急腹症\u201d。\r\n[解析]结核性腹膜炎早期腹痛不明显，以后可呈持续性隐痛或钝痛，疼痛多位于脐周、下腹，不会像阑尾炎那样呈转移性疼痛，因此答案应选C。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"721","all_num":"822","types":0,"pname":"内科学"},{"id":"403","name":"对高度怀疑肠结核的病例中，下列最有利于临床诊断的是：","data":{"A":"抗结核治疗2〜6周有效","B":"PPD试验阳性","C":"有肠外结核","D":"有腹痛、腹泻、右下腹压痛"},"da_an":"A","typeid":"117","time":"2005-07-01 16:16:59","xiang_jie":"[答案]A\r\n[考点]肠结核的诊断\r\n[考点还原]（P380-P381）\u201c对高度怀疑肠结核的病例，如抗结核治疗数周内（2～6周）症状明显改善，2～3个月后肠镜检查病变明显改善或好转，可作出肠结核的临床诊断\u201d（A对）。\r\n[解析]肠结核的诊断依据临床表现特点、X线钡剂检查和结肠镜检查结果，对高度怀疑肠结核的病例中，如抗结核治疗2〜6周有效，可作出肠结核的临床诊断，因此答案应选A。其余三个选项可有利于诊断，但均无确诊意义。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"726","all_num":"827","types":0,"pname":"内科学"},{"id":"409","name":"非甾体抗炎药（NSAID）引起的消化性溃疡，当不能停用NSAID时，首选的治疗药物是：","data":{"A":"雷尼替丁","B":"硫糖铝","C":"西沙必利","D":"奥美拉唑"},"da_an":"D","typeid":"117","time":"2005-07-01 16:18:22","xiang_jie":"[答案]D\r\n[考点]非甾体抗炎药（NSA1D）引起的消化性溃疡的治疗\r\n[考点还原]（七版内科学P394）\u201c（四）NSAID溃疡的治疗、复发预防及初始预防\u2026对不能停用NSAID者，应首选PPI治疗（H\u2082RA疗效差）\u201d（D对）。\r\n[解析]对服用NSAID后出现的溃疡的治疗，如情况允许应立即停用NSAID，对不能停用NSAID者，应首选质子泵抑制剂（PPI）即奥美拉唑治疗，因此答案应选D。而其他药物的疗效均较差，特别是西沙必利仅为胃肠动力药，疗效会更差。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"680","all_num":"828","types":0,"pname":"内科学"},{"id":"414","name":"下列胃食管反流病的临床表现中，不属于食管外刺激症状的是：","data":{"A":"咳嗽","B":"哮喘","C":"胸痛","D":"声嘶"},"da_an":"C","typeid":"117","time":"2005-07-01 16:19:38","xiang_jie":"[答案]C\r\n[考点]胃食管反流病的临床表现\r\n[考点还原]（P357）\u201c（一）食管症状\u20262.非典型症状  胸痛由反流物刺激食管引起，发生于胸骨后\u201d（C错，为本题正确答案）。（P357）\u201c（二）食管外症状  由反流物刺激或损伤食管以外的组织或器官引起，如咽喉炎、慢性咳嗽和哮喘\u201d（AB对）。\r\n[解析]胃食管反流病的临床表现多样，包括反流物刺激食管引起的表现和食管以外的刺激表现，选项中只有胸痛是属于反流物刺激食管引起的表现，而其余三个选项均为食管以外刺激症状，属于食管以外刺激症状的还有咽喉炎和吸入性肺炎的表现等，因此答案应选C。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"673","all_num":"814","types":0,"pname":"内科学"},{"id":"420","name":"男性，35岁，患肠易激综合征5年，近1个月来排便困难，粪便干结，伴失眠、焦虑。下列不宜选用的治疗药物是：","data":{"A":"甲基纤维素","B":"聚乙二醇","C":"洛哌丁胺","D":"阿米替林"},"da_an":"C","typeid":"117","time":"2018-11-20 14:46:52","xiang_jie":"[答案]C\r\n[考点]肠易激综合征（IBS）的治疗\r\n[考点还原]（（P399）\u201c4.抗抑郁药  常用的有三环类抗抑郁药如阿米替林（D对）、选择性5-羟色胺再摄取的抗抑郁药如帕罗西汀等，宜从小剂量开始，注意药物的不良反应\u201d。（P400）\u201c2.止泻药  洛哌丁胺或地芬诺酯止泻效果好，适用于腹泻症状较重者\u201d（C错，为本题正确答案）。（P400）\u201c泻药  对便秘型患者酌情使用泻药，宜使用作用温和的轻泻剂以减少不良反应和药物依赖性。常用的有渗透性轻泻剂如聚乙二醇、乳果糖或山梨醇，容积性泻药如甲基纤维素等也可选用\u201d（AB对）。\r\n[解析]题干中的病人是患便秘型IBS,因而应酌情使用泻药，但不宜选用止泻药，选项中的洛哌丁胺属于止泻药，所以不宜选用。因此答案应选C。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"632","all_num":"816","types":0,"pname":"内科学"},{"id":"425","name":"男性，30岁，腹痛、腹泻、间断低热3年，结肠镜见回肠末段病变呈跳跃性，见纵行溃疡，溃疡周围黏膜呈鹅卵石样。最可能的诊断是：","data":{"A":"溃疡性结肠炎","B":"溃疡型肠结核","C":"肠伤寒","D":"克罗恩病"},"da_an":"D","typeid":"117","time":"2005-07-01 16:21:53","xiang_jie":"[答案]D\r\n[考点]克罗恩病的诊断依据\r\n[考点还原]（P390）\u201c多见于末端回肠和邻近结肠，但从口腔至肛门各段消化道均可受累，呈节段性或跳跃式分布。临床以腹痛、腹泻、体重下降、腹块、瘘管形成和肠梗阻为特点，可伴有发热等全身表现及关节、皮肤、眼、口腔黏膜等肠外损害\u201d（P391）\u201c（三）肠镜检查 \u2026可见阿弗他溃疡或纵行溃疡，黏膜鹅卵石样改变，肠腔狭窄或肠壁僵硬，炎性息肉，病变之间黏膜外观正常，病变呈节段性、非对称性分布\u201d（D对）。\r\n[解析]该病人病史较长（3年），因此肯定不是肠伤寒，而结肠镜发现病变在回肠末段，这也不符合溃疡性结肠炎，因为溃疡性结肠炎的病变多在直肠和乙状结肠。病变部位符合溃疡型肠结核和克罗恩病，但结肠镜所见支持克罗恩病的诊断，因此答案应选D。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"738","all_num":"818","types":0,"pname":"内科学"},{"id":"433","name":"男性，47岁，腹胀、纳差半年，6小时前突然呕血约1000ml来急诊，既往HBsAg（＋）。查体示P 125次/分，BP 70/50mmHg,巩膜轻度黄染，肝脾肋下未触及，移动性浊音（＋），下肢有可凹性水肿。引起呕血的最可能病因是：","data":{"A":"胃癌","B":"肝硬化","C":"消化性溃疡","D":"胆囊结石"},"da_an":"B","typeid":"117","time":"2005-07-01 16:23:37","xiang_jie":"[考点还原]（P419）\u201c乙型肝炎病毒感染为最常见的病因\u201d（P421）\u201c1.肝功能减退  （1）消化吸收不良：食欲减退、恶心、厌食，腹胀\u2026（3）黄疸\u2026（7）低蛋白血症：患者常有下肢水肿及腹水\u201d（P421）\u201c2.门静脉高压\u2026（1）腹水\u201d（P423）\u201c门静脉高压是导致曲张静脉出血的主要原因，诱因多见于粗糙食物、胃酸侵蚀、腹内压增高及剧烈咳嗽等。临床表现为突发大量呕血或柏油样便，伴出血性休克等\u201d（B对）。[答案]B\t\r\n[考点]肝硬化的诊断和处理\r\n[解析]该中年男性病人，有腹胀、纳差病史及HBsAg（＋），最可能是有乙型病毒性肝炎病史，突然大量呕血，查体发现黄疸和腹水，可能原有脾大而因大出血后缩小，所以呕血最可能的病因是肝硬化，由于食管胃底静脉曲张破坏出血，而胃癌、消化性溃疡和胆囊结石的临床表现与上述不同。因为该病人大量呕血已处于早期休克状态，所以首选的处理措施是紧急输血和输液，而其余三个选项均不是首选处理措施。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"766","all_num":"807","types":0,"pname":"内科学"},{"id":"440","name":"男性，47岁，腹胀、纳差半年，6小时前突然呕血约1000ml来急诊，既往HBsAg（＋）。查体示P 125次/分，BP 70/50mmHg,巩膜轻度黄染，肝脾肋下未触及，移动性浊音（＋），下肢有可凹性水肿。应首选的处理措施是：","data":{"A":"急诊胃镜止血","B":"剖腹探查","C":"紧急输血和输液","D":"三腔二囊管压迫"},"da_an":"C","typeid":"117","time":"2005-07-01 16:25:15","xiang_jie":"[考点还原]（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（C对）。[答案]C\r\n[考点]肝硬化的诊断和处理\r\n[解析]该中年男性病人，有腹胀、纳差病史及HBsAg（＋），最可能是有乙型病毒性肝炎病史，突然大量呕血，查体发现黄疸和腹水，可能原有脾大而因大出血后缩小，所以呕血最可能的病因是肝硬化，由于食管胃底静脉曲张破坏出血，而胃癌、消化性溃疡和胆囊结石的临床表现与上述不同。因为该病人大量呕血已处于早期休克状态，所以首选的处理措施是紧急输血和输液，而其余三个选项均不是首选处理措施。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"638","all_num":"825","types":0,"pname":"内科学"},{"id":"444","name":"对肝炎后肝硬化的诊断下列哪项最有价值：","data":{"A":"脾大","B":"蜘蛛痣","C":"肝功能不正常","D":"超声波显示肝回声不均质","E":"食管钡餐检查下段有蚯蚓样充盈缺损"},"da_an":"E","typeid":"117","time":"2005-07-01 16:26:29","xiang_jie":"[答案]E\r\n[考点]肝炎后肝硬化的诊断\r\n[考点还原]  八版内科学未明确说明。\r\n[分析]食管钡餐检查下段有蚯蚓样充盈缺损，提示为肝硬化特有的食管下段静脉曲张的征象，因而对诊断肝硬化最有价值，而其他几项仅提示肝脏可能有病，无特异性诊断价值。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"649","all_num":"821","types":0,"pname":"内科学"},{"id":"448","name":"关于肠结核的临床表现，下列哪项不正确：","data":{"A":"腹泻是溃疡型肠结核的主要临床表现之一","B":"腹部肿块主要见于增生型肠结核","C":"多见于青少年与壮年","D":"多数起病缓慢","E":"多不伴有肺结核"},"da_an":"E","typeid":"117","time":"2005-07-01 16:27:43","xiang_jie":"[答案]E\r\n[考点]肠结核的临床表现\r\n[考点还原]（P379）\u201c肠结核是结核分枝杆菌引起的肠道慢性特异性感染\u201d（D对）。（P379）\u201c90％以上的肠结核主要由人型结核分枝杆菌引起，多因患开放性肺结核或喉结核而吞下含菌痰液、或常与开放性肺结核患者共餐而忽视餐具消毒等而被感染\u201d（E错，为本题正确答案）。（P379）\u201c本病一般见于中青年，女性稍多于男性\u201d（C对）。（P379）\u201c溃疡型肠结核常伴腹泻\u201d（A对）。（P379）\u201c腹部肿块多位于右下腹，质中、较固定、轻至中度压痛。多见于增生型肠结核\u201d（B对）。\r\n[解析]肠结核患者多有开放性肺结核，因经常吞下含结核杆菌的痰液而致病，因而肠结核多不伴有肺结核的提法是不正确的。其他描述的四个临床表现均符合肠结核。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"757","all_num":"810","types":0,"pname":"内科学"},{"id":"459","name":"患者男，50岁，半年来反复出现腹泻，粪便糊样，时有腹泻和便秘交替。检查轻度贫血貌，右下腹部可扪及肿块，胃肠X线检查示回盲部钡剂充盈缺损，考虑最不像哪个病：","data":{"A":"结肠癌","B":"Crohn病","C":"血吸虫病性肉芽肿","D":"肠结核","E":"慢性溃疡性结肠炎"},"da_an":"E","typeid":"117","time":"2005-07-01 16:30:04","xiang_jie":"[答案]E\r\n[考点]消化系统疾病鉴别诊断\r\n[考点还原]（P379）\u201c（二）大便习惯改变  溃疡型肠结核常伴腹泻，粪便呈糊样，多无脓血，不伴里急后重。有时腹泻与便秘交替。（三）腹部肿块  多位于右下腹\u201d（P379）\u201c（四）全身症状和肠外结核表现  结核毒血症状多见于溃疡型肠结核，为长期不规则低热、盗汗、消瘦、贫血和乏力\u201d（D错）。（P391）\u201c2.腹泻  亦为本病常见症状\u2026粪便多为糊状，一般无脓血和黏液。3.腹部包块  多位于右下腹与脐周\u201d（P391）\u201c（二）全身表现  主要表现为体重下降，可有贫血、低蛋白血症和维生素缺乏等表现\u201d（B错）。（P385-P386）\u201c病变多自直肠开始，逆行向近段发展，可累及全结肠甚至末端回肠\u201d（P386）\u201c1.腹泻和黏液脓血便  见于绝大多数患者\u201d（E对）。（P395）\u201c我国发病年龄多在40～60岁，发病高峰在50岁左右\u201d（P395）\u201c也可表现为腹泻与糊状大便，或腹泻与便秘交替，粪质无明显黏液脓血\u201d（P395）\u201c（三）腹部肿块\u201d（P395）\u201c（五）全身情况  可有贫血、低热，多见于右侧结直肠癌\u201d（A错）。\r\n[解析]本例的突出特点是右下腹扪及肿块，X线检查示回盲部钡剂充盈缺损，因此病变常累及右半肠管的结肠癌、Crohn病、血吸虫病性肉芽肿和肠结核均可能性大，而慢性溃疡性结肠炎主要累及直肠、乙状结肠和降结肠，较少累及右半肠管，而且很少有肉芽肿形成，仅偶有假息肉形成，因此最不像。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"561","all_num":"819","types":0,"pname":"内科学"},{"id":"463","name":"患者女，25岁，昨晚吃剩饭一碗，当夜发生上腹痛，持续恶心、呕吐。体温36.5℃，上腹部压痛，肠鸣音活跃。白细胞总数、分类及粪常规正常，首先考虑：","data":{"A":"急性胃炎","B":"急性胰腺炎","C":"胃溃疡","D":"胆囊炎","E":"胃神经官能症"},"da_an":"A","typeid":"117","time":"2005-07-01 16:31:42","xiang_jie":"[答案]A\r\n[考点]消化系统疾病鉴别诊断\r\n[考点还原]（P364）\u201c【临床表现】 常有上腹痛、胀满、恶心、呕吐和食欲不振等\u201d。\r\n[解析]本例患者发病很急，有明确吃剩饭史，表现为胃部症状，不发热，应首先考虑急性胃炎，而急性胰腺炎和胆囊炎可发病急，但常伴发热，白细胞数常增高，本例不支持，胃溃疡和胃神经官能症常有相应病史，本例未提及，故也不首先考虑。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"648","all_num":"789","types":0,"pname":"内科学"},{"id":"467","name":"肝硬化患者在很短时间里出现腹痛和大量血性腹水，不伴有发热，应首先考虑可能并发：","data":{"A":"原发性腹膜炎","B":"继发性肝癌","C":"结核性腹膜炎","D":"肝肾综合征","E":"门静脉血栓形成"},"da_an":"E","typeid":"117","time":"2005-07-01 16:32:57","xiang_jie":"[答案]E\r\n[考点]肝硬化并发症\r\n[考点还原]（P424）\u201c（四）门静脉血栓形成或海绵样变\u2026急性或亚急性发展时，表现为中、重度腹胀痛或突发剧烈腹痛、脾大、顽固性腹水、肠坏死、消化道出血及肝性脑病等，腹穿可抽出血性腹水\u201d（E对）。\r\n[解析]肝硬化患者在很短时间里出现腹痛和大量血性腹水，不伴有发热，应首先考虑可能并发门静脉血栓形成，其他四种情况虽可使腹水加重，但原发性腹膜炎和结核性腹膜炎常伴发热，血性腹水较少，继发性肝癌进展应慢性，不会在很短时间里加重，肝肾综合征较少出现腹痛和血性腹水。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"649","all_num":"754","types":0,"pname":"内科学"},{"id":"470","name":"治疗消化性溃疡时，应用下列何种药物抑制胃酸和胃蛋白酶分泌最有效：","data":{"A":"酸泵抑制剂","B":"H2受体拮抗剂","C":"M胆碱受体阻滞剂","D":"胃泌素受体拮抗剂","E":"胃酸中和剂"},"da_an":"A","typeid":"117","time":"2005-07-01 16:34:14","xiang_jie":"[答案]A\r\n[考点]消化性溃疡的药物治疗\r\n[考点还原]（P372）\u201cPPI使H\u207a-K\u207a-ATP酶失去活性，抑酸作用很强，可使胃内达到无酸水平。由于PPI与H\u207a-K\u207a-ATP酶结合后，其作用是不可逆的\u2026PPI多在2～3天内控制症状，溃疡愈合率略高于H\u2082受体拮抗剂，对一些难治性溃疡的疗效优于H\u2082受体拮抗剂\u201d（A对BCDE错）。\r\n[解析]酸泵抑制剂如奥美拉唑（Ome-prazole）是抑制胃酸和胃蛋白酶分泌最有效的药物，几乎完全抑制胃酸分泌。其他四种药物虽然有效，但均较酸泵抑制剂弱。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"646","all_num":"793","types":0,"pname":"内科学"},{"id":"474","name":"与维生素B12吸收有关的内因子是由胃黏膜中哪种细胞产生的：","data":{"A":"表层柱状上皮","B":"黏液细胞","C":"主细胞","D":"壁细胞","E":"G细胞"},"da_an":"D","typeid":"117","time":"2005-07-01 16:35:53","xiang_jie":"[答案]D\r\n[考点]胃的分泌功能\r\n[考点还原]（P196）\u201c壁细胞在分泌盐酸的同时，也分泌一种被称为内因子的糖蛋白\u201d（D对）。\r\n[解析]这是道记忆题，内因子是由胃黏膜中的壁细胞产生的，其他细胞均不产生内因子，有的则产生其他物质，如G细胞产生胃泌素，主细胞产生胃蛋白酶原，黏液细胞产生碱性黏液。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"668","all_num":"762","types":0,"pname":"内科学"},{"id":"481","name":"误服下列哪种药物中毒应该洗胃：","data":{"A":"石炭酸","B":"醋酸","C":"水杨酸类","D":"硝酸","E":"氯化高汞"},"da_an":"C","typeid":"117","time":"2005-07-01 16:37:28","xiang_jie":"[答案]C\r\n[考点]洗胃的适应证\r\n[考点还原]（P875）\u201c表9-2-1  常见急性中毒诊治要点\u201d（P879）\u201c（3）洗胃\u20262）禁忌证：吞服强腐蚀性毒物\u201d（P875）\u201c表9-2-1  常见急性中毒诊治要点\u201d（P879）\u201c（3）洗胃\u20262）禁忌证：吞服强腐蚀性毒物\u201d（B错）。\r\n[解析]水杨酸类中毒应该洗胃，否则会经胃大量吸收而加重毒性。石炭酸、醋酸、硝酸和氯化高汞对胃黏膜均有腐蚀作用，插胃管洗胃有引起胃穿孔的危险，故不宜洗胃。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"437","all_num":"731","types":0,"pname":"内科学"},{"id":"484","name":"以下哪种物质可使下食管括约肌张力增高：","data":{"A":"盐酸","B":"内因子","C":"胃蛋白酶","D":"胃泌素","E":"钙通道拮抗剂"},"da_an":"D","typeid":"117","time":"2005-07-01 16:38:36","xiang_jie":"[答案]D\r\n[考点]使下食管括约肌张力增高的物质\r\n[考点还原]（七版生理学P172）\u201c食物入胃后可引起的胃泌素和胃动素等的释放，使LES（食管下括约肌）收缩\u201d（D对）。\r\n[解析]由胃G细胞分泌的胃泌素可使下食管括约肌张力增高，而钙通道拮抗剂可使其降低，盐酸、内因子和胃蛋白酶对其影响不大。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"443","all_num":"821","types":0,"pname":"内科学"},{"id":"487","name":"溃疡性结肠炎患者腹痛、腹泻明显时，应用M胆碱受体阻断药剂量过大，可能引起下列哪项并发症：","data":{"A":"机械性肠梗阻","B":"肠穿孔","C":"中毒性结肠扩张","D":"结肠大出血","E":"以上均不是"},"da_an":"C","typeid":"117","time":"2005-07-01 16:39:51","xiang_jie":"[答案]C\r\n[考点]溃疡性结肠炎的并发症\r\n[考点还原]（P387）\u201c（一）中毒性巨结肠\u2026常因低钾、钡剂灌肠、使用抗胆碱能药物或阿片类制剂而诱发\u201d（C对）。\r\n[解析]M胆碱受体阻断药能抑制迷走神经，松弛肠道平滑肌，因此剂量过大时会引起中毒性结肠扩张，可能会引起麻痹性肠梗阻，而不会引起机械性肠梗阻，也不会引起肠穿孔和结肠大出血。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"606","all_num":"762","types":0,"pname":"内科学"},{"id":"491","name":"原发性肝癌的发生与下列哪种因素最有关：","data":{"A":"肠道戊型肝炎病毒感染","B":"肠道寄生虫感染","C":"肠道细菌感染","D":"黄曲霉毒素污染","E":"酒精中毒"},"da_an":"D","typeid":"117","time":"2005-07-01 16:41:03","xiang_jie":"[答案]D\r\n[考点]原发性肝癌的病因\r\n[考点还原]（P429）\u201c【病因和发病机制】\u2026（二）食物及饮水\u2026长期进食霉变食物（粮食受到黄曲霉素污染）或含亚硝胺食物、食物缺乏微量元素及饮用藻类毒素污染的水等都与肝癌发生有密切关系\u201d（七版病理学P195）\u201c黄曲霉菌、青霉菌等可以引起实验性肝癌，尤其是黄曲霉素B\u2081与肝细胞肝癌的密切关系受到人们的高度重视\u201d（D对）。\r\n[解析]经动物实验和流行病学调查发现，黄曲霉素的代谢产物黄曲霉毒素B1有强烈的致肝癌作用，但尚未发现原发性肝癌与肠道戊型肝炎病毒感染、肠道寄生虫感染、肠道细菌感染、酒精中毒有相关性，而与乙型肝炎病毒感染可能有一定关系。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"628","all_num":"763","types":0,"pname":"内科学"},{"id":"496","name":"患者女性，28岁，右下腹痛、腹泻伴关节酸痛、低热半年，查体心肺正常，腹软，右下腹触及可疑肿块，X线钡餐检查显示回盲部有钡影跳跃征象（Stierlin\u2019s sign）,最可能的诊断是：","data":{"A":"Crohn病（克罗恩病）","B":"肠结核","C":"阿米巴痢疾","D":"右半结肠癌","E":"溃疡性结肠炎"},"da_an":"B","typeid":"117","time":"2018-09-13 16:04:46","xiang_jie":"[答案]B\r\n[考点]肠结核的诊断和鉴别诊断\r\n[考点还原]（P379）\u201c（一）腹痛  多位于右下腹或脐周\u2026（二）大便习惯改变  溃疡型肠结核常伴腹泻\u2026（三）腹部肿块  多位于右下腹 \u201d（P380）\u201c结核毒血症状多见于溃疡型肠结核，为长期不规则低热\u201d（P380）\u201c溃疡型肠结核，钡剂于病变肠段呈现激惹征象，排空很快，充盈不佳，而在病变的上、下肠段则钡剂充盈良好，称为X线钡剂激惹征\u201d（B对）。\r\n[解析]本例患者的特点是右下腹触及可疑肿块，X线钡餐检查显示回盲部有钡影跳跃征象（Stierlin\u2019s sign），结合病史最可能的诊断是肠结核，而Crohn病和右半结肠癌虽可在右下腹触及可疑肿块，但X线不支持，阿米巴痢疾和溃疡性结肠炎时的体征和X线不支持。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"532","all_num":"745","types":0,"pname":"内科学"},{"id":"501","name":"消化性溃疡的命名主要是由于：","data":{"A":"溃疡发生于消化道","B":"溃疡影响消化功能","C":"溃疡形成与消化道功能障碍有关","D":"溃疡形成与胃酸和胃蛋白酶消化作用有关","E":"溃疡形成与消化道激素排泌紊乱有关"},"da_an":"D","typeid":"117","time":"2005-07-01 16:44:32","xiang_jie":"[答案]D\r\n[考点]消化性溃疡的发病机制\r\n[考点还原]（七版内科学P387）\u201c消化性溃疡主要指发生在胃和十二指肠的慢性溃疡\u2026因溃疡形成与胃酸/胃蛋白酶的消化作用有关而得名\u201d（D对）。\r\n[解析]消化性溃疡的命名主要是由于溃疡的形成与胃酸和胃蛋白酶消化作用有关，而其他提法均不确切。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"608","all_num":"734","types":0,"pname":"内科学"},{"id":"505","name":"判断胃酸缺乏最可靠的指标是：","data":{"A":"呕吐物无酸","B":"空腹胃液pH为7","C":"BAO为0","D":"MAO为0","E":"空腹胃液中游离酸为0"},"da_an":"D","typeid":"117","time":"2005-07-01 16:45:39","xiang_jie":"[答案]D\r\n[考点]判断胃酸缺乏的指标\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]MAO（maximal acid output,最大胃酸分泌）是指给予刺激后连续收集1小时胃液所测泌酸值，若无酸，即MAO为0，是胃酸缺乏最可靠的指标；BAO（basic acid output,基础胃酸分泌）是指抽取空腹胃液后，再连续收集1小时胃液所测泌酸值，未加刺激剂，若为0，刺激后还可能会有酸分泌，因此不如MAO可靠；呕吐物无酸、空腹胃液pH为7（中性表示无酸）和空腹胃液中游离酸为0还不如BAO可靠。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"547","all_num":"731","types":0,"pname":"内科学"},{"id":"510","name":"误服下列哪种药物应禁忌洗胃：","data":{"A":"东莨菪碱","B":"水杨酸盐","C":"氢氧化钠","D":"盐酸麻黄碱","E":"亚硝酸盐类"},"da_an":"C","typeid":"117","time":"2005-07-01 16:46:41","xiang_jie":"[答案]C\r\n[考点]中毒洗胃的禁忌证\r\n[考点还原]（P879）\u201c（3）洗胃\u20262）禁忌证：吞服强腐蚀性毒物、食管静脉曲张、惊厥或昏迷患者，不宜进行洗胃\u201d（P875）\u201c表9-2-1  常见急性中毒诊治要点\u201d（C对）。\r\n[解析]氢氧化钠属于强碱，是强腐蚀性毒物，误服后若插胃管洗胃有可能引起胃穿孔，故应视为禁忌，其他几种药物均可洗胃。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"477","all_num":"626","types":0,"pname":"内科学"},{"id":"515","name":"患有幽门螺杆菌相关性胃炎的病人，给予哪种抗生素最为宜：","data":{"A":"四环素","B":"红霉素","C":"庆大霉素","D":"先锋霉素Ⅳ","E":"阿莫西林"},"da_an":"E","typeid":"117","time":"2005-07-01 16:47:52","xiang_jie":"[答案]E\r\n[考点]治疗幽门螺杆菌的抗生素\r\n[考点还原]（P366）\u201c1.Hp相关胃炎  单独应用表4-4-1所列药物，均不能有效根除Hp。这些抗生素在酸性环境下不能正常发挥其抗菌作用，需要联合PPI抑制胃酸后，才能使其发挥作用。常用的联合方案有：1种PPI+2种抗生素或1种铋剂+2种抗生素，疗程7～14天\u201d。（P366）\u201c表4-4-1  具有杀灭和抑制Hp作用的药物\u201d（E对）。\r\n[解析]实验室药敏试验和临床经验均表明，阿莫西林是治疗幽门螺杆菌相关胃炎的最佳抗生素，其余几种抗生素均不能与之相比拟。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"637","all_num":"713","types":0,"pname":"内科学"},{"id":"519","name":"在肠结核的治疗中，下列哪一项不正确：","data":{"A":"为使病人早日康复，防止耐药性的产生，目前多采用长程抗结核治疗","B":"一般用异烟肼与利福平二种杀菌药联合","C":"开始治疗1〜2周即有症状改善","D":"腹痛可用抗胆碱能药物","E":"伴完全肠梗阻者应手术治疗"},"da_an":"A","typeid":"117","time":"2005-07-01 16:49:25","xiang_jie":"[答案]A\r\n[考点]肠结核的治疗\r\n[考点还原]（P71）\u201c（1）每日用药方案：①强化期：异烟肼、利福平、吡嗪酰胺和乙胺丁醇，顿服，2个月。②巩固期：异烟肼、利福平，顿服，4个月。简写为：2HRZE/4HR\u201d（B对）。（P381）\u201c（二）对症治疗  腹痛可用抗胆碱能药物\u201d（D对）。（P381）\u201c（三）手术治疗  适应证①完全性肠梗阻或部分性肠梗阻内科治疗无效者\u201d（E对）。\r\n[解析]在肠结核的治疗中，过去一般进行长程标准治疗，疗程在1〜1.5年，目前认为，为使病人早日康复，防止耐药性的产生，多采用短程化疗，疗程为6〜9个月，因此长程化疗是过去的观点，是不正确的。其余几项治疗均是正确的。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"539","all_num":"759","types":0,"pname":"内科学"},{"id":"526","name":"关于原发性肝癌的转移，下列哪项提法不正确：","data":{"A":"肝内血行转移发生最早，也最常见","B":"容易侵犯门静脉分支形成癌栓","C":"肝外血行转移中，转移至肺的几达半数","D":"经淋巴转移至肝门淋巴结的最多","E":"种植转移常见"},"da_an":"E","typeid":"117","time":"2005-07-01 16:50:35","xiang_jie":"[答案]E\r\n[考点]原发性肝癌的转移方式\r\n[考点还原]（P430）\u201c1.肝内转移  易侵犯门静脉及分支并形成癌栓（B对），脱落后在肝内引起多发性转移灶\u201d。（P430）\u201c2.肝外转移  ①血行转移：最常见转移至肺（C对）\u2026②淋巴转移：常见肝门淋巴结转移（D对）\u2026③种植转移：少见（E错，为本题正确答案）\u201d。\r\n[解析]关于原发性肝癌的转移，种植转移少见，因此常见的提法不正确。其余关于原发性肝癌转移的提法均是正确的。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"570","all_num":"729","types":0,"pname":"内科学"},{"id":"529","name":"下列哪项不符合由胃泌素瘤引起的消化性溃疡：","data":{"A":"多发生在球后十二指肠降段和横段，或空肠近端","B":"常规胃手术后不易复发","C":"易并发出血、穿孔和梗阻","D":"基础胃酸分泌过度","E":"常伴腹泻"},"da_an":"B","typeid":"117","time":"2005-07-01 16:51:44","xiang_jie":"[答案]B\r\n[考点]消化性溃疡的鉴别诊断\r\n[考点还原]（P372）\u201c（三）Zollinger-Ellison综合征\u2026该综合征由促胃液素瘤或促胃液素细胞增生所致，临床以高胃酸分泌（D对），血促胃液素水平升高，多发、顽固及不典型部位消化性溃疡及腹泻为特征（E对）\u2026多数溃疡位于十二指肠球部和胃窦小弯侧，其余分布于食管下段、十二指肠球后及空肠等非典型部位（A错）\u201d。（七版内科学P391）\u201c胃泌素瘤与普通消化性溃疡的鉴别要点是该病溃疡发生于不典型部位，具难治性特点\u201d（B错，为本题正确答案）。\r\n[解析]由胃泌素瘤引起的消化性溃疡非常难治，常规胃手术后都见复发，因此胃手术后不易复发的提法不符合由胃泌素瘤引起的消化性溃疡，而其他几项均符合。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"611","all_num":"717","types":0,"pname":"内科学"},{"id":"533","name":"下列哪个不是有机磷中毒时的毒蕈碱样表现：","data":{"A":"恶心、呕吐和腹痛、腹泻","B":"多汗","C":"肌肉颤动","D":"瞳孔缩小","E":"心率减慢"},"da_an":"C","typeid":"117","time":"2005-07-01 16:52:45","xiang_jie":"[答案]C\r\n[考点]有机磷中毒的临床表现\r\n[考点还原]（P885）\u201c1.毒蕈碱样症状  又称M样症状。主要是副交感神经末梢过度兴奋，产生类似毒蕈碱样作用。平滑肌痉挛表现：瞳孔缩小（D对），胸闷、气短、呼吸困难，恶心、呕吐、腹痛、腹泻（A对）；括约肌松弛表现：大小便失禁；腺体分泌增加表现：大汗（B对）、流泪和流涎\u201d。（P885）\u201c2.烟碱样症状  又称N样症状。在横纹肌神经肌肉接头处ACh蓄积过多，出现肌纤维颤动（C错，为本题正确答案）\u201d。\r\n[解析]几个选项中肌肉颤动是有机磷中毒时的烟碱样表现，而其余几项均属于毒蕈碱样表现。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"521","all_num":"652","types":0,"pname":"内科学"},{"id":"539","name":"下列哪项是以结合胆红素增高为主的黄疸：","data":{"A":"溶血性黄疸","B":"肝炎后高胆红素血症","C":"Gilbert综合征","D":"Crigber-Najjar综合征","E":"Dubin-Johnson综合征"},"da_an":"E","typeid":"117","time":"2005-07-01 16:53:54","xiang_jie":"[答案]E\r\n[考点]黄疸的鉴别诊断\r\n[考点还原]（八版诊断学P38）\u201c1.溶血性黄疸  实验室检查血清UCB增加为主，CB基本正常\u201d（A错）。（八版诊断学P38）\u201c2.肝细胞性黄疸  实验室检查血清中CB与UCB均增加，黄疸型肝炎时，CB增加幅度多高于UCB\u201d（B错）。（八版诊断学P38）\u201cGlbert综合征（C错）：系由肝细胞摄取UCB功能障碍及微粒体内葡萄糖醛酸转移酶不足，致血中UCB增高而出现黄疸\u201d。（八版诊断学P38）\u201cDubin-Johnson综合征（E对）：系由肝细胞对CB及某些阴离子向毛细胆管排泄发生障碍，致血清CB增加而发生的黄疸\u201d。 （八版诊断学P38-P39）\u201cCrigler-najjar综合征（D错）：系由肝细胞缺乏葡萄糖醛酸转移酶，致UCB不能形成CB，导致血中UCB增多而出现黄疸\u201d。\r\n[解析]Dubin-Johnson综合征是肝细胞对结合胆红素、BSP、靛青绿等有遗传性分泌排泄功能缺陷的疾病，因而会发生高结合胆红素血症。而溶血性黄疸、肝炎后高胆红素血症、Gilbert综合征和Crigber-Najjar综合征则分别由于非结合胆红素来源过多、摄取障碍和因葡萄糖醛酸转移酶活力减低或缺如使非结合胆红素转变为结合胆红素发生障碍所致，所以都是以非结合胆红素增高为主的黄疸。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"302","all_num":"721","types":0,"pname":"内科学"},{"id":"544","name":"现在认为下列哪项最不可能引起溃疡性结肠炎：","data":{"A":"结肠的感染","B":"变态反应","C":"细胞免疫异常","D":"遗传","E":"过敏反应"},"da_an":"A","typeid":"117","time":"2005-07-01 16:54:56","xiang_jie":"[答案]A\r\n[考点]溃疡性结肠炎的病因\r\n[考点还原]（P385）\u201c【病因和发病机制】 由环境、遗传（D错）、感染（A错）和免疫（BCE错）多因素相互作用所致\u201d。\r\n[解析]溃疡性结肠炎的病因尚未完全明确，目前一般认为其发病主要是由于免疫机制异常，并与遗传因素有关，而感染在本病发病中的地位尚难肯定，因此结肠感染最不可能引起溃疡性结肠炎。\r\n\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"532","all_num":"753","types":0,"pname":"内科学"},{"id":"3566","name":"肝硬化腹水患者，应首选的利尿剂为：","data":{"A":"甘露醇","B":"利尿酸钠（依他尼酸)","C":"双氢氯噻嗪（氢氯噻嗪)","D":"安体舒通（螺内酯）","E":"速尿（呋塞米）"},"da_an":"D","typeid":"117","time":"2018-11-17 17:31:40","xiang_jie":"[答案]D\r\n[考点]肝硬化腹水的治疗\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]肝硬化腹水的形成原因之一是继发性醛固酮增多，而安体舒通（螺内酯）有抗醛固酮作用，临床实践证明安体舒通对肝硬化腹水病人有明显利尿效果，因此首选。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"660","all_num":"712","types":0,"pname":"内科学"},{"id":"3567","name":"患者男，50岁，既往体健，查体时发现肝在右季肋下2cm，质硬、无压痛，脾可触及，ALT正常范围，肝穿刺病理有假小叶形成，应诊断为：","data":{"A":"慢性活动性肝炎","B":"慢性持续性肝炎","C":"代偿期肝硬化","D":"肝淤血","E":"多囊肝"},"da_an":"C","typeid":"117","time":"2018-08-05 21:08:00","xiang_jie":"[答案]C\r\n[考点]肝硬化的诊断\r\n[考点还原]（P420）\u201c【发病机制及病理】\u2026汇管区和肝包膜的纤维束向肝小叶中央静脉延伸扩展，这些纤维间隔包绕再生结节或将残留肝小叶重新分割，改建成为假小叶，形成典型的肝硬化组织病理形态\u201d。（P421）\u201c（一）代偿期  大部分患者无症状或症状较轻，可有腹部不适、乏力、食欲减退、消化不良和腹泻等症状\u2026患者营养状态尚可，肝脏是否肿大取决于不同类型的肝硬化，脾脏因门静脉高压常有轻、中度肿大。肝功能实验检查正常或轻度异常\u201d（C对）。\r\n[解析]此病人肝脾肿大，但ALT在正常范围，因而不是慢性活动性或持续性肝炎，病理有假小叶形成，因而不符合肝淤血和多囊肝，应诊断为代偿期肝硬化。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"643","all_num":"691","types":0,"pname":"内科学"},{"id":"3569","name":"胆汁郁积性黄疸时，下列哪项正确：","data":{"A":"血清总胆固醇降低 ","B":"血清结合胆红素降低","C":"血清碱性磷酸酶降低","D":"血清γ-谷氨酰转肽酶降低","E":"尿胆原降低"},"da_an":"E","typeid":"117","time":"2018-09-13 14:18:38","xiang_jie":"[答案]E\r\n[考点]胆汁郁积性黄疸的实验室检查特点\r\n[考点还原]（八版诊断学P38）\u201c实验室检查血清CB增加为主（B错）\u2026因肠肝循环途径被阻断，故尿胆原（E对）及粪胆原减少或缺如。血清碱性磷酸酶（C错）及总胆固醇（A错）升高\u201d。（P366）\u201c因此当肝内合成亢进或胆汁排出受阻时，血清中GGT（γ-谷氨酞转肽酶）（B错）增高\u201d。\r\n[解析]胆汁郁积性黄疸时，由于胆红素的\u201c肠肝循环\u201d受阻，应该使尿胆原降低，因而答案是E，其余四项均应升高，因此降低是不正确的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"409","all_num":"699","types":0,"pname":"内科学"},{"id":"3572","name":"下列哪一项不符合重度溃疡性结肠炎：","data":{"A":"腹泻每日6次以上","B":"体温达38℃以上","C":"脉搏在90次/分以上","D":"红细胞沉降率大于30mm/第1小时","E":"血红蛋白在100g/L以下"},"da_an":"B","typeid":"117","time":"2018-08-05 21:10:08","xiang_jie":"[答案]B\r\n[考点]重度溃疡性结肠炎的临床特点\r\n[考点还原]（P386-P387）\u201c2.临床严重程度\u2026重度：腹泻＞6次/日（A对），有明显黏液脓血便，体温＞37.5℃（B错，为本题正确答案）、脉搏＞90次/分（C对），血红蛋白＜100g/L（E对），血沉＞30mm/h（D对）\u201d。\r\n[解析]这是道记忆题，重度溃疡性结肠炎体温应该是达37.5℃以上，因而B不符合，其余各项均符合。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"412","all_num":"727","types":0,"pname":"内科学"},{"id":"3573","name":"下列哪种肝硬化引起肝性脑病最多见：","data":{"A":"酒精性肝硬化","B":"原发性胆汁性肝硬化","C":"淤血性肝硬化","D":"肝炎后肝硬化","E":"血吸虫病性肝硬化"},"da_an":"D","typeid":"117","time":"2018-09-13 14:20:00","xiang_jie":"[答案]D\r\n[考点]肝性脑病的病因\r\n[考点还原]（P419）\u201c【病因】 在我国，目前引起肝硬化的病因以病毒性肝炎为主\u201d（P434）\u201c【病因与发病机制】 大部分肝性脑病由肝硬化引起\u201d（D对）。\r\n[解析]肝炎后肝硬化是由乙型、丙型或乙型加丁型肝炎重叠感染，通常经过慢性肝炎，尤其是慢性活动性肝炎阶段演变而来，在我国肝硬化中占首位，引起肝性脑病亦最常见，因而答案是D。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"566","all_num":"678","types":0,"pname":"内科学"},{"id":"3575","name":"克罗恩（Crohn）病最常见的并发症是：","data":{"A":"腹腔内脓肿","B":"吸收不良综合征","C":"肠梗阻","D":"大量便血","E":"发生癌变"},"da_an":"C","typeid":"117","time":"2018-09-13 14:21:02","xiang_jie":"[答案]C\r\n[考点]克罗恩病的并发症\r\n[考点还原]（P391）\u201c【并发症】 肠梗阻最常见（C对），其次是腹腔内脓肿（A错），偶可并发急性穿孔或大量便血（D错）。直肠或结肠黏膜受累者可发生癌变（E错）\u201d。\r\n[解析]所列举五种并发症在克罗恩病时均可发生，但最常见的是肠梗阻。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"649","all_num":"686","types":0,"pname":"内科学"},{"id":"3577","name":"关于A型胃炎，下列哪项是正确的：","data":{"A":"较常见","B":"大多数由幽门螺杆菌感染引起","C":"病变主要累及胃体和胃底","D":"发病与遗传素质无关","E":"最终不易导致恶性贫血\t"},"da_an":"C","typeid":"117","time":"2018-11-11 11:50:55","xiang_jie":"[答案]C\r\n[考点]A型胃炎的特点\r\n[考点还原]（八版病理学P189）\u201c表9-1  慢性萎缩性胃炎A、B型比较表\u201d（C对ABDE错）。\r\n[解析]A型胃炎又称慢性胃体炎，病变主要累及胃体和胃底，该病不常见，主要由自身免疫反应引起，最终可导致恶性贫血，常有遗传因素参与发病，因而答案是C。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"630","all_num":"694","types":0,"pname":"内科学"},{"id":"3578","name":"关于消化性溃疡的癌变下列哪项是正确的","data":{"A":"各种消化性溃疡均有癌变可能","B":"癌变发生于溃疡边缘","C":"癌变率可达1%以上","D":"症状经严格的4周内科治疗无改善","E":"癌变率与年龄无关"},"da_an":"B","typeid":"117","time":"2018-09-13 14:22:33","xiang_jie":"[答案]B\r\n[考点]消化性溃疡的癌变\r\n[考点还原]（P371）\u201c（四）癌变  溃疡由良性演变为恶性的几率很低，估计＜1％胃溃疡有可能癌变，十二指肠球部溃疡一般不发生癌变\u201d（AC错）。（七版内科学P392）\u201cGU癌变发生于溃疡边缘（B对），据报道癌变率在1％左右。长期慢性GU病史、年龄在45岁以上（E错）、溃疡顽固不愈者应提高警惕\u201d。（七版内科学P400）\u201c胃溃疡经正规治疗2个月无效，X线钡餐提示溃疡增大者\u201d（D错）。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"498","all_num":"695","types":0,"pname":"内科学"},{"id":"3581","name":"肝硬化失代偿期病人的下列检查中，哪项不正确：","data":{"A":"凝血因子减少","B":"血红蛋白减低","C":"雄激素减少","D":"雌激素减少","E":"肾上腺糖皮质激素可减少"},"da_an":"D","typeid":"117","time":"2018-09-13 14:23:57","xiang_jie":"[答案]D\r\n[考点]肝硬化失代偿期临床表现\r\n[考点还原]（P421）\u201c1.肝功能减退\u2026（4）出血和贫血（B对）：常有鼻腔、牙龈出血及皮肤黏膜瘀点、瘀斑和消化道出血等，与肝合成凝血因子减少（A对）、脾功能亢进和毛细血管脆性增加有关\u201d。（P421）\u201c1.肝功能减退\u2026（5）内分泌失调  ①性激素代谢：常见雌激素增多（D错，为本题正确答案），雄激素减少（C对）\u2026②肾上腺皮质功能：肝硬化时，合成肾上腺皮质激素重要的原料胆固醇酯减少，肾上腺皮质激素合成不足（E对）\u201d。\r\n[解析]肝硬化失代偿期病人，雌激素应该是增高而不是减少，而凝血因子、雄激素和肾上腺皮质激素均可减少，血红蛋白减低，因而答案是D。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"633","all_num":"719","types":0,"pname":"内科学"},{"id":"3583","name":"对幽门螺杆菌感染阳性的消化性溃疡治疗策略中，下列哪项不正确：","data":{"A":"给制酸剂同时加抗菌治疗","B":"给黏膜防护剂同时加抗菌治疗","C":"制酸剂可用H2受体拮抗剂或质子泵阻滞剂","D":"制酸剂应用疗程在DU应适当较GU时延长","E":"抗生素首选一种，以二周为一疗程"},"da_an":"D","typeid":"117","time":"2018-11-21 11:50:43","xiang_jie":"[答案]D\r\n[考点]幽门螺杆菌阳性的消化性溃疡治疗\r\n[考点还原]（七版内科学P393）\u201c研究证明以PPI（A对）或胶体铋（B对）为基础加上两种抗生素（E错）的三联治疗方案有较高根除率\u201d。\r\n[答案]D\r\n[解析]对幽门螺杆菌感染阳性的消化性溃疡治疗策略中，制酸剂在DU疗程为4〜6周，而GU因溃疡愈合较慢，疗程应适当延长至8〜12周，DE均错误，原答案为D.\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"519","all_num":"756","types":0,"pname":"内科学"},{"id":"3586","name":"Cushing ulcer是指由下列哪种原因引起者：","data":{"A":"严重的脏器疾病","B":"大手术","C":"大面积烧伤","D":"休克","E":"中枢神经病变\t"},"da_an":"E","typeid":"117","time":"2018-09-13 14:26:49","xiang_jie":"[答案]E\r\n[考点]急性胃炎的病因\r\n[考点还原]（P472）\u201c（三）应激性溃疡或急性糜烂性溃疡  约占20％。近年来，其发生率有明显上升。多与休克、复合性创伤、严重感染、严重烧伤（Curling溃疡）（D错）、严重脑外伤（Cushing溃疡）或大手术有关\u201d。\r\n[解析]这是一道记忆题，Cushing ulcer是指中枢神经病变引起者。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"500","all_num":"747","types":0,"pname":"内科学"},{"id":"3589","name":"下列哪一项属于胃十二指肠黏膜防卫因子：","data":{"A":"胃酸/胃蛋白酶","B":"前列腺素","C":"胆盐","D":"胰酶","E":"药物（NSAID"},"da_an":"B","typeid":"117","time":"2018-09-13 14:28:16","xiang_jie":"[答案]B\r\n[考点]消化性溃疡的病因和发病机制\r\n[考点还原]（P369）\u201c消化性溃疡发病的机制是胃酸、胃蛋白酶的侵袭作用与黏膜的防御能力间失去平衡\u201d（A错）。（P369）\u201cNSAIDs是导致胃黏膜损伤最常用的药物\u201d（E错）。（P369）\u201c十二指肠-胃反流可导致胃黏膜损伤\u201d（CD错）。（七版内科学P393）\u201c米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用，主要用于NSAID溃疡的预防\u201d（B对）。\r\n[解析]这是一道记忆题，前列腺素属于胃十二指肠黏膜防卫因子。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"590","all_num":"728","types":0,"pname":"内科学"},{"id":"3590","name":"结核性腹膜炎的抗结核治疗，下列哪项不正确：","data":{"A":"其疗效一般比溃疡型肠结核略好","B":"粘连型合并渗出者，病变不易控制","C":"一般用3〜4种药物联合强化治疗","D":"继发于体内其他结核病的病人，临床多选用以往未用或少用药物","E":"有血行播散或严重结核毒性症状者，可短期加用肾上腺糖皮质激素"},"da_an":"A","typeid":"117","time":"2018-09-13 14:29:05","xiang_jie":"[答案]A\r\n[考点]结核性腹膜炎的抗结核治疗\r\n[考点还原]（P73）\u201c（二）糖皮质激素  糖皮质激素治疗结核病的应用主要是利用其抗炎、消毒作用，仅用于结核毒性症状严重者\u201d（E对）。\r\n[解析]结核性腹膜炎的抗结核治疗，其疗效一般比溃疡型肠结核略差，而不是略好，因而不正确，而其他四项均是正确的，因而答案是A。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"505","all_num":"727","types":0,"pname":"内科学"},{"id":"3593","name":"肝硬化病人引起肝肾综合征的因素中，下列哪项不正确：","data":{"A":"去甲肾上腺素分泌增加","B":"肾素-血管紧张素Ⅱ系统活性增强","C":"肾前列腺素合成增加","D":"血栓素A2增加","E":"白三烯产生增加"},"da_an":"C","typeid":"117","time":"2018-09-13 14:30:51","xiang_jie":"[答案]C\r\n[考点]肝硬化时肝肾综合征发生机制\r\n[考点还原] （十四版实用内科学P2001）\u201c5.泌尿系统  肝硬化患者肝窦压升高，NO增加，造成内脏动脉扩张，有效血容量不足，反射性激活肾素-血管紧张素（B对）和交感系统（A对）产生肾动脉极度收缩，造成肾内血供过度不足，产生肝肾综合征\u201d。\r\n[解析]肝硬化病人引起肝肾综合征的因素很多，这些因素使肾血管收缩，引起肾皮质血流量和肾小球滤过率持续降低，题中列举的因素除C外均是正确的，因为前列腺素是使血管扩张，所以病人的肾前列腺素合成是减少而不是增加，故答案是C。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"497","all_num":"686","types":0,"pname":"内科学"},{"id":"3595","name":"肝硬化病人肝肾综合征的特点是：","data":{"A":"血BUN↑ 血钠↑ 尿钠↑","B":"血BUN↑ 血钠↑ 尿钠↓","C":"血BUN↑ 血钠↓ 尿钠↓","D":"血BUN↓ 血钠↓ 尿钠↓","E":"血BUN↑ 血钠↓ 尿钠↑"},"da_an":"C","typeid":"117","time":"2018-09-13 14:31:39","xiang_jie":"[答案]C\r\n[考点]肝硬化时肝肾综合征的特点\r\n[考点还原]（七版内科学P450）\u201c（六）肝肾综合征\u2026HRS临床表现为自发性少尿或无尿，氮质血症和血肌酐升高，稀释性低钠血症，低尿钠\u201d（C对）。\r\n[解析]肝肾综合征是由于肝硬化病人少尿或无尿而引起的氮质血症、稀释性低钠血症和低尿钠，因此血BUN↑、血钠↓、尿钠↓是正确的，而其余各项均不正确。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"614","all_num":"673","types":0,"pname":"内科学"},{"id":"3597","name":"Curling ulcer是指下列哪项原因引起者：","data":{"A":"大手术","B":"休克","C":"大面积烧伤","D":"颅内病变","E":"严重的脏器疾病"},"da_an":"C","typeid":"117","time":"2018-09-13 14:32:40","xiang_jie":"[答案]C\r\n[考点]急性胃炎的病因\r\n[考点还原]（P472）\u201c（三）应激性溃疡或急性糜烂性溃疡  约占20％。近年来，其发生率有明显上升。多与休克、复合性创伤、严重感染、严重烧伤（Curling溃疡）（C对）、严重脑外伤（Cushing溃疡）（D错）或大手术有关\u201d。\r\n[解析]Curling ulcer是指大面积烧伤引起的应激性溃疡，而其余各项均不是。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"551","all_num":"657","types":0,"pname":"内科学"},{"id":"3600","name":"有关肝癌的临床表现，下列哪项不正确：","data":{"A":"可完全不痛或仅有轻微钝痛","B":"不会出现急腹症表现","C":"有时表现为膈抬高","D":"位于肋弓下的癌结节最易被触到","E":"有时可在腹壁上听到吹风样血管杂音"},"da_an":"B","typeid":"117","time":"2018-09-13 14:33:34","xiang_jie":"[答案]B\r\n[考点]肝癌的临床表现\r\n[考点还原]（P430）\u201c（一）肝区疼痛\u2026如癌肿生长缓慢，则可完全无痛或仅有轻微钝痛（A对）。当肝表面的癌结节破裂，可突然引起剧烈腹痛，从肝区开始迅速延至全腹，产生急腹症的表现（B错，为本题正确答案），如出血量大时可导致休克\u201d。（P430）\u201c（二）肝大\u2026肝癌突出于右肋弓下或剑突下时，上腹可呈现局部隆起或饱满（D对）；如癌肿位于膈面，则主要表现为膈肌抬高（C对）而肝下缘不下移\u201d。\r\n[解析]当肝表面的癌结节破裂，使坏死的癌组织及血液进入腹腔时，可产生急腹症表现，因而\u201c不会出现急腹症表现\u201d不正确。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"512","all_num":"643","types":0,"pname":"内科学"},{"id":"3602","name":"肝性脑病的脑性毒物中，下列哪项不正确","data":{"A":"氨","B":"芳香族氨基酸","C":"γ-氨基丁酸","D":"蛋氨酸的代谢产物\u2014\u2014硫醇","E":"中链脂肪酸"},"da_an":"E","typeid":"117","time":"2018-09-13 14:34:36","xiang_jie":"[答案]E\r\n[考点]肝性脑病的发病机制\r\n[考点还原]（P434）\u201c（一）氨中毒  氨代谢紊乱引起氨中毒是肝性脑病、特别是门-体分流性肝性脑病的重要发病机制\u201d（A对）\u2026（二）神经递质的变化  1.γ-氨基丁酸/苯二氮䓬（GABA/BZ）神经递质（C对）\u2026复合体中任何一个受体被激活均可促使氯离子内流而使神经传导被抑制\u20262.假性神经递质\u2026食物中的芳香族氨基酸（B对）如酪氨酸、苯丙氨酸等经肠菌脱羧酶的作用分别转变为酪胺和苯乙胺\u2026在脑内经β羟化酶的作用分别形成β羟酪胺和苯乙醇胺\u2026称为假性神经递质。当假性神经递质被脑细胞摄取并取代了突触中的正常递质，则神经传导发生障碍\u201d。\r\n[解析]氨、芳香族氨基酸、γ-氨基丁酸、蛋氨酸的代谢产物\u2014\u2014硫醇均为肝性脑病的脑性毒物，而中链脂肪酸则不是，应该是短链脂肪酸。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"443","all_num":"611","types":0,"pname":"内科学"},{"id":"3604","name":"急性坏死性胰腺炎时，下列哪项检查结果正确：","data":{"A":"血清淀粉酶均升高","B":"血清脂肪酶早期升高","C":"血糖升高","D":"血钙升高","E":"血白蛋白升高"},"da_an":"C","typeid":"117","time":"2018-09-13 14:36:02","xiang_jie":"[答案]C\r\n[考点]急性坏死性胰腺炎的实验室检查\r\n[考点还原]（P441）\u201c2.脂肪酶  血清脂肪酶于起病后24～72小时开始升高（B错）\u201d。（P441）\u201c血清淀粉酶、脂肪酶的高低与病情程度无确切关联，部分患者的两种胰酶可不升高（AB错）\u201d。（P441）\u201c表4-18-2  反映SAP病理生理变化的实验室检测指标\u201d（C对DE错）。\r\n[解析]急性坏死性胰腺炎时，血糖是升高，而血清淀粉酶可升高，但也可低于正常，血清脂肪酶早期不升高，血钙是降低，血白蛋白不会升高，而是正铁血由蛋白升高。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"452","all_num":"632","types":0,"pname":"内科学"},{"id":"3606","name":"下列导致十二指肠溃疡胃酸分泌异常的因素中哪项不正确：","data":{"A":"壁细胞对胃泌素特别敏感","B":"胃酸反馈性抑制机制失灵","C":"对进餐刺激后的胃酸分泌在溃疡活动期增强","D":"晚间胃酸分泌明显增多","E":"胃排空减慢"},"da_an":"E","typeid":"117","time":"2018-09-13 14:37:16","xiang_jie":"[答案]E\r\n[考点]消化性溃疡的发病机制\r\n[考点还原]（七版内科学P389）\u201c研究发现部分DU患者胃排空增快，这可使十二指肠球部酸负荷增大\u201d（E错，为本题正确答案）。（十四版实用内科学P1915）\u201c胃酸分泌增多的因素包括：1.壁细胞数量增多；2.壁细胞对刺激物质的敏感性增强（AC对）；3.胃酸分泌正常反馈抑制机制缺陷（B对）；4.迷走神经张力增高（D对）\u201d。\r\n[解析]十二指肠溃疡病人有胃排空加速现象，这可提高十二指肠的酸负荷，因而\u201c胃排空减慢\u201d不正确，其余各项均正确。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"435","all_num":"629","types":0,"pname":"内科学"},{"id":"3609","name":"下列哪一项不是肝硬化代偿期的表现：","data":{"A":"乏力、食欲减退","B":"食管和胃底静脉曲张","C":"肝脏质地结实或偏硬","D":"脾脏中度肿大","E":"肝功能轻度异常"},"da_an":"B","typeid":"117","time":"2018-09-13 14:38:16","xiang_jie":"[答案]B\r\n[考点]肝硬化的临床表现\r\n[考点还原]（P421）\u201c（一）代偿期  大部分患者无症状或症状较轻，可有腹部不适、乏力、食欲减退（A对）、消化不良和腹泻等症状\u2026脾脏因门静脉高压常有轻、中度肿大（D对）。肝功能实验室检查正常或轻度异常（E对）\u201d。（P421）\u201c失代偿期  症状较明显，主要有肝功能减退和门静脉高压两类临床表现\u20262.门静脉高压 多属肝内型，门静脉高压常导致食管胃底静脉曲张\u201d（B错，为本题正确答案）。（七版内科学P448）\u201c代偿期肝硬化  症状轻且无特异性。可有乏力、食欲减退、腹胀不适等。患者营养状况一般，可触及肿大的肝脏、质偏硬（C对），脾可肿大。肝功能检查正常或仅有轻度酶学异常\u201d。\r\n[解析]肝硬化的临床表现包括代偿期和失代偿期的表现，代偿期的表现缺乏特异性，而失代偿期表现包括肝功能减退的临床表现和门静脉高压症，食管和胃底静脉曲张是门静脉高压症的三大表现之一，故答案是B。\r\n636.[答案]B\r\n[考点]肝硬化的临床表现\r\n[解析]肝硬化的临床表现包括代偿期和失代偿期的表现，代偿期的表现缺乏特异性，而失代偿期表现包括肝功能减退的临床表现和门静脉高压症，食管和胃底静脉曲张是门静脉高压症的三大表现之一，故答案是B。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"515","all_num":"605","types":0,"pname":"内科学"},{"id":"3611","name":"下列哪一种并发症在溃疡性结肠炎最少见：","data":{"A":"中毒性结肠扩张","B":"直肠结肠癌变","C":"直肠结肠大量出血","D":"肠梗阻","E":"瘘管形成"},"da_an":"E","typeid":"117","time":"2018-11-11 10:48:56","xiang_jie":"[答案]E\r\n[考点]溃疡性结肠炎的并发症\r\n[考点还原]（P386）\u201c由于结肠病变一般限于黏膜与黏膜下层，很少深入肌层，所以并发结肠穿孔、瘘管（E对）或周围脓肿少见\u201d。\r\n[解析]题中所列五项均为溃疡性结肠炎的并发症，以中毒性结肠扩张最常见，而瘘管形成最少见。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"435","all_num":"641","types":0,"pname":"内科学"},{"id":"3613","name":"下列哪一种药物常作为根除幽门螺杆菌的基础药物：","data":{"A":"甲氰咪呱","B":"雷尼替丁","C":"奥美拉唑","D":"碳酸钙","E":"胶体铝镁合剂"},"da_an":"C","typeid":"117","time":"2018-09-13 14:40:19","xiang_jie":"[答案]C\r\n[考点]溃疡病的幽门螺杆菌治疗\r\n[考点还原]（七版内科学P393）\u201cPPI及胶体铋体也能抑制幽门螺旋杆菌\u201d（C对）。\r\n[解析]溃疡病的幽门螺杆菌治疗常以质子泵抑制剂（PPI）或胶体铋剂为基础药物，加两种抗菌药物治疗。奥美拉唑是PPI中常用的一种，因此答案是C，其余均不是。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"571","all_num":"589","types":0,"pname":"内科学"},{"id":"3615","name":"关于十二指肠溃疡（DU）的描述，下列哪项不正确：","data":{"A":"DU患者中，2/3有胃酸分泌过高现象","B":"壁细胞总数小于10亿个不会发生DU","C":"MAO小于10mmol/h不会发生DU","D":"由幽门螺杆菌引起的DU均有胃窦炎存在","E":"DU有导致胃酸分泌异常的多种因素"},"da_an":"A","typeid":"117","time":"2018-09-13 14:41:52","xiang_jie":"[答案]A\r\n[考点]十二指肠溃疡的发病机制\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]十二指肠溃疡的发病与胃酸密切相关，但有胃酸分泌过高现象者仅约1/3，所以该题答案是A，而其余各项均可见于十二指肠溃疡。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"262","all_num":"605","types":0,"pname":"内科学"},{"id":"3617","name":"B型胃炎主要是由下列哪个原因引起：","data":{"A":"幽门螺杆菌感染","B":"胆汁反流","C":"消炎药物","D":"吸烟","E":"酒癖"},"da_an":"A","typeid":"117","time":"2018-09-13 14:43:21","xiang_jie":"[答案]A\r\n[考点]B型胃炎的病因\r\n[考点还原]（八版病理学P189）\u201c表9-1  慢性萎缩性胃炎A、B型比较表\u201d（A对）。\r\n[解析]B型胃炎又称慢性胃窦炎，已明确绝大多数（90%）是由幽门螺杆菌感染引起，仅少数由于其余原因包括胆汁反流、消炎药物（非甾体抗炎药）、吸烟和酒癖等所致，所以答案是A。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"565","all_num":"569","types":0,"pname":"内科学"},{"id":"3619","name":"出血坏死型胰腺炎时的Cullen征是指：","data":{"A":"胁腹皮肤呈灰紫色斑","B":"脐周皮肤呈灰紫色斑","C":"胁腹皮肤青紫","D":"脐周皮肤青紫","E":"脐周皮肤红斑"},"da_an":"D","typeid":"117","time":"2018-09-13 14:46:35","xiang_jie":"[答案]D\r\n[考点]出血坏死型胰腺炎的临床表现\r\n[考点还原]（七版内科学P471）\u201c少数患者因胰酶、坏死组织及出血沿腹膜间隙与肌层渗入腹壁下，致两侧胁腹部皮肤呈暗灰蓝色，称Grey-Turner征；可致脐周围皮肤青紫，称Cullen征（D对）\u201d。\r\n[解析]出血坏死型胰腺炎时因胰酶、坏死组织及出血沿腹膜间隙与肌层渗入腹壁下，致脐周围皮肤青紫，称Cullen征，故答案是D。而胁腹皮肤青紫称Grey-Furner征，其余三项亦不正确。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"386","all_num":"589","types":0,"pname":"内科学"},{"id":"3622","name":"下列H2RA药物中，抑酸作用最强且持久而副作用少的是：","data":{"A":"西咪替丁","B":"雷尼替丁","C":"法莫替丁","D":"尼扎替丁","E":"罗沙替丁"},"da_an":"C","typeid":"117","time":"2018-09-13 14:47:26","xiang_jie":"[答案]C\r\n[考点]消化性溃疡的抑酸药物治疗\r\n[考点还原]（八版药理学P304）\u201c表32-1\u201d（C对）。\r\n[解析]题中所列五种药物均为H2受体拮抗剂（H2RA），其中以法莫替丁的抑酸作用最强而持久，口服20mg对胃酸分泌的抑制作用能维持12小时以上，而且无明显副作用。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"496","all_num":"579","types":0,"pname":"内科学"},{"id":"3624","name":"关于肝性脑病的氨中毒学说下列正确的是：","data":{"A":"NH4＋有毒性，能透过血脑屏障","B":"肠内pH＞6时，NH3不易被吸收","C":"低钾碱中毒时增加氨毒性","D":"腹泻时增加氨毒性","E":"高血糖时增加氨毒性"},"da_an":"C","typeid":"117","time":"2018-09-13 14:48:52","xiang_jie":"[答案]C\r\n[考点]肝性脑病的氨中毒学说\r\n[考点还原]（P434）\u201c（一）氨中毒\u2026氨以非离子型氨（NH\u2083）和离子型氨（NH\u2084\u207a）两种形式存在，氨在肠道的吸收主要以NH\u2083弥散入肠黏膜，当结肠内pH＞6时，NH\u2084\u207a转为NH\u2083，大量弥散入血（C对B错）；pH＜6时，则NH\u2083从血液转至肠腔，随粪排泄\u2026游离的NH\u2083有毒性，且能透过血脑屏障（A错）\u201d。\r\n[解析]低钾碱中毒时，可促使NH3透过血脑屏障，进入脑细胞产生毒害，故低钾碱中毒时增加氨毒性，而其余各项均不正确。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"439","all_num":"576","types":0,"pname":"内科学"},{"id":"3626","name":"结核性腹膜炎病人的发热特点错误的是：","data":{"A":"一半有弛张热","B":"少数可呈稽留热","C":"高热伴明显毒血症者见于渗出型","D":"高热伴明显毒血症者见于干酪型","E":"高热伴明显毒血症者见于伴有粟粒型结核者"},"da_an":"A","typeid":"117","time":"2018-09-13 14:49:49","xiang_jie":"[答案]A\r\n[考点]结核性腹膜炎病人的发热特点\r\n[考点还原]（七版内科学P406）\u201c结核毒血症常见，主要是发热与盗汗。热型以低热与中等热为最多，约1/3患者有弛张热（A错，为本题正确答案），少数可呈稽留热（B对）。高热伴有明显毒血症主要见于渗出型（C对）、干酪型（D对），或见于伴有粟粒型肺结核（E对）、干酪样肺炎等严重结核病的患者\u201d。\r\n[解析]结核性腹膜炎病人以低热和中等热为最多，只有约1/3病人呈弛张热，不会达到一半，因而答案是A，其余均是正确的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"463","all_num":"578","types":0,"pname":"内科学"},{"id":"3628","name":"对于肠易激综合征病人，下列有关腹痛的描述，错误的是：","data":{"A":"部位不定","B":"以下腹和右下腹多见","C":"极少睡眠中痛醒","D":"多于排便或排气后缓解","E":"无明显体征"},"da_an":"B","typeid":"117","time":"2018-08-05 21:30:54","xiang_jie":"[答案]B\r\n[考点]肠易激综合征病人的腹痛特点\r\n[考点还原]（P400）\u201c【临床表现】\u2026几乎所有IBS患者都有不同程度的腹痛或腹部不适，部位不定（A对），以下腹和左下腹多见（B错，为本题正确答案），排便或排气后缓解（D对）。极少有睡眠中痛醒者（C对）\u201d。（P400）\u201c【临床表现】\u2026一般无明显体征\u201d（E对）。\r\n[解析]几乎所有肠易激综合征病人都有不同程度的腹痛，以下腹和左下腹多见，而不是右下腹，其余有关腹痛的描述均是正确的。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"428","all_num":"587","types":0,"pname":"内科学"},{"id":"3630","name":"下列有关胃食管反流病烧心的描述错误的是：","data":{"A":"烧心是指胸骨后或剑突下烧灼感","B":"常在餐后半小时出现","C":"腹压增高时可加重","D":"弯腰时可加重","E":"卧位可加重"},"da_an":"B","typeid":"117","time":"2018-09-13 14:51:44","xiang_jie":"[答案]B\r\n[考点]胃食管反流病的临床表现\r\n[考点还原]（P357）\u201c烧心是指胸骨后或剑突下烧灼感（A对），常由胸骨下段向上延伸。烧心和反流常在餐后1小时出现（B错，为本题正确答案），卧位（E对）、弯腰（D对）或腹压增高（C对）时可加重\u201d。\r\n[解析]烧心是胃食管反流病的最常见症状，常在餐后1小时出现，而不是半小时出现，其余均是正确的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"483","all_num":"563","types":0,"pname":"内科学"},{"id":"3634","name":"治疗重症胃食管反流病的首选药物是：","data":{"A":"雷尼替丁","B":"西沙必利","C":"奥美拉唑","D":"氢氧化铝","E":"丙谷胺"},"da_an":"C","typeid":"117","time":"2018-09-13 14:52:45","xiang_jie":"[答案]C\r\n[考点]重症胃食管反流病的治疗\r\n[考点还原]（P359）\u201c2.抑酸药\u2026（1）PPI\u2026适用于症状重、有严重食管炎的患者\u201d（C对）。\r\n[解析]重症胃食管反流病需要强的抑酸药治疗，题中所列五种药物中奥美拉唑的抑酸作用最强，因此宜首选，其余多适用于轻、中症病人。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"530","all_num":"542","types":0,"pname":"内科学"},{"id":"3636","name":"十二指肠溃疡的发病主要是因为：","data":{"A":"胃酸、胃蛋白酶等侵袭因素增强","B":"黏膜屏障减弱","C":"黏膜血流量减低","D":"细胞更新能力减弱","E":"表皮生长因子减少\t"},"da_an":"A","typeid":"117","time":"2018-09-13 14:53:30","xiang_jie":"[答案]A\r\n[考点]十二指肠溃疡的发病机制\r\n[考点还原]（P369）\u201c但胃溃疡在发病机制上以黏膜屏障功能降低为主要机制，十二指肠球部溃疡则以高胃酸分泌起主导作用\u201d（A对B错）。\r\n[解析]消化性溃疡的发生是由于胃酸、胃蛋白酶等侵袭因素增强和/或防御、修复因素减弱所致，十二指肠溃疡的发生主要以前者为主，而胃溃疡的发生主要以后者为主。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"531","all_num":"552","types":0,"pname":"内科学"},{"id":"3638","name":"下列不符合肠易激综合征腹泻特点的是：","data":{"A":"一般每日大便3〜5次","B":"大便多呈稀糊状","C":"大便多带有黏液","D":"排便常干扰睡眠","E":"大便绝对无脓血"},"da_an":"D","typeid":"117","time":"2018-09-13 14:54:47","xiang_jie":"[答案]D\r\n[考点]肠易激综合征的腹泻特点\r\n[考点还原]（P400）\u201c【临床表现】\u2026极少有睡眠中痛醒者\u201d（D错，为本题正确答案）。（P400）\u201c【临床表现】\u2026腹泻型IBS常排便较急，粪便呈糊状或稀水样（B对），一般每日3～5次左右（A对），少数严重发作期可达十余次，可带有黏液（C对），但无脓血（E对）\u201d。\r\n[解析]肠易激综合征是一种功能性肠道疾病，一般每日大便3〜5次左右，大便多呈糊状，多带有黏液，绝对无脓血，排便不影响睡眠，故答案是D。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"502","all_num":"559","types":0,"pname":"内科学"},{"id":"3639","name":"隐性肝性脑病病人的临床特点是：","data":{"A":"轻度性格改变","B":"轻度行为改变","C":"应答尚准确，但吐字稍缓慢","D":"可有扑翼样震颤","E":"无任何临床表现\t"},"da_an":"E","typeid":"117","time":"2018-08-05 21:35:50","xiang_jie":"[答案]E\r\n[考点]肝性脑病的临床表现\r\n[考点还原]（P435）\u201c0期（潜伏期） 又称轻微肝性脑病，无行为、性格异常（AB错），无神经系统病理征，脑电图正常，只在心理测试或智力测试时有轻微异常（E对CD错）\u201d。\r\n[解析]隐性肝性脑病亦称亚临床肝性脑病，无任何临床表现，而其他四种表现均是一期（前驱期）肝性脑病的临床表现。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"435","all_num":"541","types":0,"pname":"内科学"},{"id":"3640","name":"急性胰腺炎治疗时，下列属抑制胰酶活性的药物是：","data":{"A":"抑肽酶","B":"胰升糖素","C":"降钙素","D":"生长抑素","E":"奥曲肽"},"da_an":"A","typeid":"117","time":"2018-09-13 14:55:47","xiang_jie":"[答案]A\r\n[考点]急性胰腺炎的治疗\r\n[考点还原]（P443）\u201c天然生长抑素由胃肠黏膜D细胞合成，它可抑制胰泌素和缩胆囊素刺激的胰液基础分泌。急性胰腺炎时，循环中生长抑素水平显著降低，可予外源性补充生长抑素（D错）250～500μg/h，或生长抑素类似物奥曲肽（E错）25～50μg/h\u201d。\r\n[解析]急性胰腺炎的治疗，特别是出血坏死型胰腺炎早期的治疗需要抑制胰酶活性的药物，抑肽酶属于此类药物，而其余均为抑制胰液分泌的药物。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"410","all_num":"566","types":0,"pname":"内科学"},{"id":"3642","name":"诊断反流性食管炎最准确的方法是：","data":{"A":"食管吞钡X线检查","B":"食管滴酸试验","C":"食管内镜检查","D":"食管24小时pH值监测","E":"食管测压"},"da_an":"C","typeid":"117","time":"2018-09-13 14:56:44","xiang_jie":"[答案]C\r\n[考点]反流性食管炎的辅助检查\r\n[考点还原]（P358）\u201c（一）胃镜  是诊断RE最准确的方法，并能判断RE的严重程度和有无并发症\u201d（C对）。\r\n[解析]食管内镜检查是诊断反流性食管炎最准确的方法，不但可以确定诊断，并能判断反流性食管炎的严重程度和有无并发症，结合活检还可以与其他原因引起的食管炎和其他食管病变进行鉴别。而其他各项检查对诊断虽亦有帮助，但均不是最准确的诊断方法。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"514","all_num":"546","types":0,"pname":"内科学"},{"id":"3645","name":"下列关于消化性溃疡并发出血的叙述，正确的是：","data":{"A":"胃溃疡一般比十二指肠溃疡容易发生","B":"一般出血50〜100ml即可出现黑便","C":"出血超过500ml时就可引起循环障碍","D":"半小时内出血超过1000ml时均会发生休克","E":"第一次出血后很少复发\t"},"da_an":"B","typeid":"117","time":"2018-09-13 14:58:04","xiang_jie":"[答案]B\r\n[考点]消化性溃疡的出血并发症\r\n[考点还原]（P371）\u201c（一）出血\u2026十二指肠球部溃疡较胃溃疡易发生\u201d（A错）。（P371）\u201c表4-5-2  消化性溃疡出血的Forrest分型\u201d（E错）。（P453）\u201c成人每日消化道出血＞5ml，粪便潜血试验即出现阳性；每日出血量超过50ml可出现黑粪（B对）；胃内积血量＞250ml可引起呕血。一次出血量＜400ml时，因轻度血容量减少可由组织液及脾脏贮血所补充，多不引起全身症状。出血量＞400ml，可出现头昏、心悸、乏力等症状（C错）。短时间内出血量＞1000ml，可出现休克表现（D错）\u201d。\r\n[解析]出血是消化性溃疡很常见的并发症，一般十二指肠溃疡较胃溃疡易发生，一般出血达50〜100ml即可出现黑便，超过1000ml时可引起循环障碍，在半小时内出血超过1500ml时会发生休克，第一次出血后约40%可以复发，因此只有B是正确的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"452","all_num":"552","types":0,"pname":"内科学"},{"id":"3647","name":"下列关于肠结核腹泻特点的叙述错误的是：","data":{"A":"腹泻是溃疡型肠结核的主要表现之一","B":"一般不含黏液和脓液","C":"腹泻可与便秘交替","D":"常伴里急后重","E":"便血极少见"},"da_an":"D","typeid":"117","time":"2018-09-13 14:58:49","xiang_jie":"[答案]D\r\n[考点]肠结核的腹泻特点\r\n[考点还原]（P379）\u201c溃疡型肠结核常伴腹泻（A对），粪便呈糊状，多无脓血（BE对），不伴里急后重（D错，为本题正确答案）。有时腹泻与便秘交替（C对）。增生型肠结核以便秘为主\u201d。（P380）\u201c并发症见于晚期患者，以肠梗阻及合并结核性腹膜炎多见，瘘管、腹腔脓肿、肠出血（E对）少见\u201d。\r\n[解析]腹泻是肠结核（溃疡型）的主要临床表现之一，粪便呈糊状，一般不含黏液和脓液，不伴里急后重，便血极少见。腹泻与便秘交替是本病的临床特征，当然也可见于其他胃肠功能紊乱疾病。从上述看，肠结核常伴里急后重是错误的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"448","all_num":"537","types":0,"pname":"内科学"},{"id":"3650","name":"肝硬化最常见的并发症是：","data":{"A":"肝性脑病","B":"自发性腹膜炎","C":"上消化道出血","D":"肝肾综合征","E":"原发性肝癌"},"da_an":"C","typeid":"117","time":"2018-09-13 14:59:24","xiang_jie":"[答案]C\r\n[考点]肝硬化的并发症\r\n[考点还原]（七版内科学P449）\u201c（一）食管胃底静脉曲张破裂出血  为最常见的并发症\u201d（C对）。\r\n[解析]题中所列五项均为肝硬化的并发症，其中最严重的并发症是肝性脑病，但最常见的并发症是上消化道出血，多突然发生大量呕血或黑便，其余各项均相对少见。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"467","all_num":"534","types":0,"pname":"内科学"},{"id":"3651","name":"慢性胰腺炎后期，由于胰腺内分泌功能不全可引起：","data":{"A":"脂肪泻","B":"夜盲症","C":"Vit K缺乏症","D":"Vit D缺乏症","E":"糖尿病"},"da_an":"E","typeid":"117","time":"2018-09-13 15:00:16","xiang_jie":"[答案]E\r\n[考点]慢性胰腺炎的临床表现\r\n[考点还原]（P446）\u201c3.胰腺内分泌功能不全的表现  由于慢性胰腺炎引起胰腺β细胞破坏，半数患者可发生糖尿病\u201d（E对）。（P446）\u201c2.胰腺外分泌功能不全的表现  慢性胰腺炎后期，由于胰腺外分泌功能障碍可引起食欲减退、食后上腹饱胀，消瘦，营养不良，水肿，及维生素A（B错）、D（D错）、E、K（C错）缺乏等症状。部分患者由于胰腺外分泌功能明显不足而出现腹泻，大便每日3～4次，色淡、量多、有气泡。恶臭，大便内脂肪量增多（A错）并有不消化的肌肉纤维\u201d。\r\n[解析]慢性胰腺炎后期，可以出现胰腺功能不全表现，由于胰腺外分泌功能障碍可引起脂肪泻、夜盲症、Vit K缺乏症和Vit D缺乏症，约半数的慢性胰腺炎病人可因胰腺内分泌功能不全发生糖尿病。因此本题E是正确答案。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"326","all_num":"552","types":0,"pname":"内科学"},{"id":"3653","name":"下列用于胃食管反流病维持治疗的药物中，效果最好的是：","data":{"A":"西沙必利","B":"吗丁啉（多潘立酮）","C":"氢氧化铝","D":"西咪替丁","E":"奥美拉唑"},"da_an":"E","typeid":"117","time":"2018-09-13 15:01:04","xiang_jie":"[答案]E\r\n[考点]胃食管反流病的维持治疗\r\n[考点还原]（P359）\u201c（二）维持治疗\u2026PPI和H\u2082RA均可用于维持治疗，PPI效果更优\u201d（E对D错）。\r\n[解析]胃食管反流病具有慢性复发倾向，为减少症状复发，防止食管炎反复复发引起的并发症，需给予维持治疗，题中的五种药物均可用于维持治疗，西沙必利和吗丁啉（多潘立酮）是促胃动力药，氢氧化铝是碱性抗酸药，西咪替丁是H2受体拮抗剂，奥美拉唑是质子泵抑制剂，其中奥美拉唑抑酸作用强，维持治疗效果最好，所以答案是E。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"518","all_num":"530","types":0,"pname":"内科学"},{"id":"3656","name":"在慢性胃炎的发病机制中，与幽门螺杆菌感染无关的因素是：","data":{"A":"产生胃壁细胞抗体","B":"分泌空泡毒素A","C":"释放尿素酶分解尿素产生NH3","D":"产生细胞毒素相关基因蛋白","E":"菌体胞壁作为抗原诱导免疫反应"},"da_an":"A","typeid":"117","time":"2018-09-13 15:01:36","xiang_jie":"[答案]A\r\n[考点]幽门螺杆菌感染在慢性胃炎发病中的作用\r\n[考点还原]（P364）\u201cHp产生的尿素酶可分解尿素，产生的氨可中和反渗入黏液内的胃酸，形成有利于Hp定居和繁殖的局部微环境，使感染慢性化\u201d（C对）。（P364）\u201cHp凭借其产生的氨及空泡毒素导致细胞损伤；促进上皮细胞释放炎症介质；菌体细胞壁Lewis X、Lewis Y抗原引起自身免疫反应\u201d（BE对）。（七版内科学P383）\u201c其细胞毒素相关基因（cagA）蛋白能引起强烈的炎症反应\u201d（D对）。\r\n解析]胃壁细胞抗体是人体内的自身抗体，引起自身免疫性胃炎，即A型胃炎，而幽门螺杆菌感染是引起B型胃炎，除选项A外的其余四项均与幽门螺杆菌感染有关，幽门螺杆菌是通过这四项引起慢性胃炎的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"436","all_num":"529","types":0,"pname":"内科学"},{"id":"3658","name":"下列关于结核性腹膜炎全身症状的叙述，错误的是：","data":{"A":"主要症状是发热和盗汗","B":"热型以低热和中等热量多","C":"约1/3患者呈弛张热","D":"少数可呈稽留热","E":"毒血症状明显者见于粘连型"},"da_an":"E","typeid":"117","time":"2018-09-13 15:02:06","xiang_jie":"[答案]E\r\n[考点]结核性腹膜炎的临床表现\r\n[考点还原]（七版内科学P406）\u201c结核毒血症常见，主要是发热与盗汗（A对）。热型以低热与中等热为最多（B对），约1/3患者有弛张热（C对），少数可呈稽留热（D对）。高热伴有明显毒血症主要见于渗出型、干酪型，或见于伴有粟粒型肺结核、干酪样肺炎等严重结核病的患者（E错，为本题正确答案）\u201d。\r\n[解析]结核性腹膜炎的全身结核毒血症状常见，主要是发热与盗汗，热型以低热和中等热最多，约1/3患者有弛张热，少数可呈稽留热，毒血症状明显者主要见于渗出型、干酪型或见于伴有粟粒型肺结核、干酪样肺炎等严重结核病的患者，不见于粘连型患者，因此E项是错误的。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"476","all_num":"550","types":0,"pname":"内科学"},{"id":"3723","name":"不支持肠易激综合征诊断的临床表现是：","data":{"A":"每天排便多于3次","B":"每周排便少于3次","C":"块状/硬粪便","D":"稀水样便","E":"粪便排出顺利，无不尽感\t"},"da_an":"E","typeid":"117","time":"2018-09-13 15:03:09","xiang_jie":"[答案]E\r\n[考点]肠易激综合征的诊断\r\n[考点还原]（P400）\u201c【诊断和鉴别诊断】\u2026以下症状不是诊断所必备，但属常见症状，这些症状越多越支持IBS的诊断：①排便频率异常（每天排便＞3次或每周＜3次）（AB对）；②粪便性状异常（块状/硬便或稀水样便）（CD对）；③粪便排出过程异常（费力、急迫感、排便不尽感）（E错，为本题正确答案）；④黏液便；⑤胃肠胀气或腹部膨胀感\u201d。\r\n[解析]以下临床表现支持肠易激综合征的诊断：①排便频率异常（每天排便＞3次或每周＜3次）；②粪便性状异常（块状/硬便或稀水样便）；③粪便排出过程异常（费力、急迫感、排便不尽感）；④黏液便；⑤胃肠胀气或腹部膨胀感。因此答案是E。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"434","all_num":"528","types":0,"pname":"内科学"},{"id":"3730","name":"男性，25岁，右下腹痛3月余，还常伴有上腹或脐周腹痛，排便次数稍多，呈糊状，不含黏液和脓血，每日2〜4次，曾作过X线钡剂检查发现回盲部有跳跃征。最可能的诊断是：","data":{"A":"克罗恩病","B":"溃疡型肠结核","C":"右侧结肠癌","D":"阿米巴病","E":"肠恶性淋巴瘤\t"},"da_an":"B","typeid":"117","time":"2018-09-13 16:07:25","xiang_jie":"[考点]肠结核的诊断和鉴别诊断\r\n[考点还原]（P379）\u201c（一）腹痛  多位于右下腹或脐周\u201d（P379）\u201c（二）大便习惯改变  溃疡型肠结核常伴腹泻，粪便呈糊状，多无脓血\u201d（P380）\u201c溃疡型肠结核，钡剂于病变肠段呈现激惹征象，排空很快，充盈不佳，而在病变的上、下肠段则钡剂充盈良好，称为X线钡剂激惹征\u201d（B对）。\r\n[解析]本例年轻患者有慢性右下腹痛病史，排便次数稍多，题中列出的五种疾病均有可能，但X线钡剂检查发现回盲部有跳跃征，这是溃疡型肠结核的典型X线表现，所以该患者最可能的诊断是溃疡型肠结核。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"440","all_num":"526","types":0,"pname":"内科学"},{"id":"3734","name":"男性，40岁，健康体检时化验血甲胎蛋白＞500μg/L，血ALT 35U/U查体未见异常。初步诊断最可能是：","data":{"A":"肝硬化代偿期","B":"肝硬化失代偿期","C":"慢性迁延性肝炎","D":"慢性活动性肝炎","E":"亚临床肝癌"},"da_an":"E","typeid":"117","time":"2018-09-13 15:04:03","xiang_jie":"[考点]原发性肝癌的诊断\r\n[考点还原]（P431）\u201c在排除妊娠和生殖腺胚胎瘤的基础上，AFP＞400ng/ml为诊断肝癌的条件之一\u201d（七版内科学P459）\u201c如AFP呈低浓度阳性持续达2个月甚至更久，ALT正常，应特别警惕亚临床肝癌的存在\u201d（七版内科学P460）\u201c【诊断】\u2026经普查检出的肝癌可无任何症状和体征，称为亚临床肝癌\u201d（E对）。\r\n[解析]本例中年男性患者在健康体检时化验血发现甲胎蛋白明显增高（＞500μg/L），而肝功能正常，查体未见异常，因此不支持肝硬化和肝炎的诊断，而原发性肝癌起病隐匿，早期缺乏典型临床表现，经甲胎蛋白普查检出的早期病例可无任何症状和体征，称为亚临床肝癌，因此答案是E","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"434","all_num":"504","types":0,"pname":"内科学"},{"id":"3738","name":"在用糖皮质激素治疗溃疡性结肠炎时，宜选用主要作用于肠道局部而全身不良反应较小的类型。下列具有此种作用的糖皮质激素是：","data":{"A":"泼尼松","B":"泼尼松龙","C":"布地奈德","D":"地塞米松","E":"琥珀酸钠氢化可的松"},"da_an":"C","typeid":"117","time":"2018-09-13 15:04:47","xiang_jie":"[考点]溃疡性结肠炎的糖皮质激素治疗\r\n[考点还原]（P389）\u201c病变局限于直肠者也可用布地奈德泡沫灌肠剂2mg保留灌肠，每晚1次，该药是以局部作用为主的糖皮质激素，故全身不良反应较少\u201d（C对）。\r\n[解析]糖皮质激素对急性发作期的溃疡性结肠炎有较好疗效，但多数糖皮质激素如泼尼松、泼尼松龙、地塞米松、琥珀酸钠氢化可的松等都是全身起作用，所以全身的不良反应较大，而布地奈德为新型糖皮质激素，主要在肠道局部起作用，所以全身不良反应大大减少。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"418","all_num":"522","types":0,"pname":"内科学"},{"id":"3744","name":"目前，对肠易激综合征的诊断推荐采用国际认同的罗马Ⅱ标准，其中有关腹部不适或腹痛时间的规定是在过去12个月内至少累计达","data":{"A":"6周","B":"8周","C":"10周","D":"12周","E":"16周"},"da_an":"D","typeid":"117","time":"2018-09-13 15:05:34","xiang_jie":"[考点还原]  八版内科学未明确说明。\r\n[解析]这是道记忆题。目前对肠易激综合征的诊断推荐采用国际认同的罗马Ⅱ标准，其中有关腹部不适或腹痛时间的规定是在过去12个月内至少累计达12周。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"377","all_num":"522","types":0,"pname":"内科学"},{"id":"3746","name":"在肝硬化的发病机制中，形成肝纤维化的主要细胞是","data":{"A":"肝星状细胞","B":"肝细胞","C":"Kupffer细胞","D":"上皮细胞","E":"内皮细胞"},"da_an":"A","typeid":"117","time":"2018-09-13 15:06:23","xiang_jie":"[考点]肝硬化时的肝纤维化形成\r\n[考点还原]（七版内科学P447）\u201c肝星状细胞（A对）是形成肝纤维化的主要细胞\u201d。\r\n[解析]近年来对肝硬化时的肝纤维化形成有较为深入的研究，如果肝的纤维组织形成增多而降解减少则可导致肝纤维化，肝星状细胞是形成纤维化的主要细胞，使胶原合成增多，此外肝细胞和Kupffer细胞亦有合成胶原的功能，而上皮细胞和内皮细胞则不会，因此答案是A。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"467","all_num":"522","types":0,"pname":"内科学"},{"id":"3750","name":"近年来开展的经颈静脉肝内门体分流术治疗肝硬化门脉高压症，其最大副作用是易诱发：","data":{"A":"肝肾综合征","B":"肝肺综合征","C":"肝性脑病","D":"感染","E":"电解质和酸碱平衡紊乱\t"},"da_an":"C","typeid":"117","time":"2018-09-13 15:07:24","xiang_jie":"[考点]肝硬化门脉高压症的颈静脉肝内门体分流术治疗\r\n[考点还原]（P441）\u201c其主要问题是支撑管可进行性狭窄和并发肝功能衰竭（5%～10%），肝性脑病（20%～40%）\u201d。\r\n[解析]近年来开展的颈静脉肝内门体分流术是一种以介入放射学的方法在肝内的门静脉与肝静脉的主要分支间建立通道，能有效降低门静脉压力，创伤小，安全性高，适用于食管静脉曲张大出血和难治性腹水，但易诱发肝性脑病，这是此疗法最大的副作用。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"479","all_num":"508","types":0,"pname":"内科学"},{"id":"3754","name":"下列选项中，属于胰腺外分泌功能的试验是","data":{"A":"维生素B12吸收试验","B":"胰功肽试验","C":"血清缩胆囊素测定","D":"空腹血浆胰岛素测定","E":"血浆胰多肽测定"},"da_an":"B","typeid":"117","time":"2018-08-06 10:51:02","xiang_jie":"[考点]测定胰腺外分泌功能的试验\r\n[考点还原]（七版内科学P477）\u201c（一）胰腺外分泌功能试验（B对） 1.直接刺激试验  胰泌素可刺激胰腺腺泡分泌胰液和碳酸氢钠\u20262.间接刺激试验  ①Lundh试验\u2026②胰功肽试验（粪弹力蛋白酶）\u2026（二）吸收功能试验  1.粪便（72小时）脂肪检查\u20262.维生素B\u2081\u2082吸收试验\u2026（四）胰腺内分泌测定  1.血清缩胆囊素\u20262.血浆胰多肽\u20263.空腹血浆胰岛素水平\u201d。\r\n[解析]测定胰腺外分泌功能的试验包括直接刺激试验和间接刺激试验两大类，选项中的胰功肽试验是属于间接刺激试验，而维生素Bl2吸收试验是属于胰腺的吸收功能试验，其余三个选项均属于胰腺内分泌功能测定试验。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"263","all_num":"551","types":0,"pname":"内科学"},{"id":"3758","name":"男性，30岁，患消化性溃疡2年余，经常反复发作，曾用过多种药物治疗。下列用过的治疗药物中，属于保护胃黏膜的药物是：","data":{"A":"法莫替丁","B":"奥美拉唑","C":"氢氧化铝","D":"西沙必利","E":"米索前列醇"},"da_an":"E","typeid":"117","time":"2018-09-13 15:08:33","xiang_jie":"[考点]消化性溃疡的药物治疗\r\n[考点还原]（P373）\u201c3.保护胃黏膜\u2026（2）弱碱性抗酸剂：常用铝碳酸镁、磷酸铝、硫糖铝、氢氧化铝凝胶等\u2026碱性抗酸剂目前更多被视为粘膜保护剂\u201d（C）。（七版内科学P393）\u201c2.保护胃黏膜药物\u2026米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用，主要用于NSAID溃疡的预防\u201d（E对）。\r\n[解析]治疗消化性溃疡的药物可分为抑制胃酸的药物和保护胃黏膜的药物两大类，保护胃黏膜的药物包括硫糖铝、米索前列醇和枸橼酸铋钾等，因此答案是E。其余除西沙必利是属于胃肠动力药外，均为抑制胃酸的药物。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"427","all_num":"522","types":0,"pname":"内科学"},{"id":"3761","name":"男性，35岁，腹泻伴左下腹轻至中度疼痛2年，每天大便4〜5次，间断便血，有疼痛\u2014便意\u2014便后缓解的规律，常有里急后重，最近结肠镜检查发现结肠黏膜粗糙呈细颗粒状，血管纹理模糊。目前最可能的诊断是","data":{"A":"肠道功能紊乱","B":"克罗恩病","C":"溃疡性结肠炎","D":"肠阿米巴病","E":"肠结核"},"da_an":"C","typeid":"117","time":"2018-09-13 15:09:21","xiang_jie":"[考点]溃疡性结肠炎的诊断\r\n[考点还原]（P385）\u201c本病可发生在任何年龄，多见于20～40岁\u201d（P386）\u201c1.腹泻和黏液脓血便\u2026黏液脓血便是本病活动期的重要表现\u201d（P386）\u201c2.腹痛  多有轻至中度腹痛，为左下腹或下腹阵痛，亦可累及全腹。常有里急后重，便后腹痛缓解\u201d（P387）\u201c（四）结肠镜\u2026内镜下所见黏膜改变有：①黏膜血管纹理模糊、紊乱或消失、充血、水肿、易脆、出血及脓性分泌物附着；②病变明显处见弥漫性糜烂和多发性浅溃疡；③慢性病变常见黏膜粗糙、呈细颗粒状，炎性息肉及桥状黏膜\u201d（C对）。\r\n[解析]该例中年男性患者是左下腹痛、腹泻，临床表现中的疼痛\u2014便意\u2014便后缓解的规律和结肠镜检查的发现均支持溃疡性结肠炎的诊断。而克罗恩病、肠阿米巴病和肠结核的病变均在右下腹，不会有左下腹痛和相应表现。肠道功能紊乱的表现多与此不同，而且结肠镜检查不会有异常。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"476","all_num":"507","types":0,"pname":"内科学"},{"id":"3770","name":"铅中毒时的解毒药物是：","data":{"A":"依地酸钠钙","B":"二巯丙醇","C":"纳洛酮","D":"亚甲蓝"},"da_an":"A","typeid":"117","time":"2018-08-06 10:56:13","xiang_jie":"[考点]急性中毒的解毒药物治疗\r\n   [考点还原]（P881）\u201c表9-2-5毒物络合剂的应用\u201d（A对）                                                    [解析]铅中毒时的解毒药物是依地酸钠钙；阿片类麻醉药中毒的解毒药物是纳洛酮。二巯丙醇是砷、汞、锑中毒的解毒药物；亚甲蓝是亚硝酸盐、苯胺、硝基苯等中毒引起的高铁血红蛋白血症的解毒药物。                                                       ","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"360","all_num":"458","types":0,"pname":"内科学"},{"id":"3772","name":"阿片类麻醉药中毒时的解毒药物是","data":{"A":"依地酸钠钙","B":"二巯丙醇","C":"纳洛酮","D":"亚甲蓝"},"da_an":"C","typeid":"117","time":"2018-09-13 15:10:29","xiang_jie":" [考点还原]（P882）\u201c1）纳洛酮：是阿片类麻醉药的解毒药，对麻醉镇痛药引起的呼吸抑制有特异性拮抗作用\u201d（C对）。\r\n[解析]铅中毒时的解毒药物是依地酸钠钙；阿片类麻醉药中毒的解毒药物是纳洛酮。二巯丙醇是砷、汞、锑中毒的解毒药物；亚甲蓝是亚硝酸盐、苯胺、硝基苯等中毒引起的高铁血红蛋白血症的解毒药物。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"403","all_num":"449","types":0,"pname":"内科学"},{"id":"3780","name":"在我国最易引起原发性肝癌的肝硬化类型是","data":{"A":"病毒性肝炎后肝硬化","B":"酒精性肝硬化","C":"淤血性肝硬化","D":"原发性胆汁性肝硬化"},"da_an":"A","typeid":"117","time":"2018-09-13 15:11:22","xiang_jie":"[考点]病毒性肝炎后肝硬化的并发症和体征\r\n[考点还原]（P429）\u201c在我国，肝癌患者中约90％有乙型肝炎病毒感染的背景。HBV感染→慢性肝炎→肝硬化→肝癌是最主要的发病机制\u201d（A对BCD错）。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"469","all_num":"490","types":0,"pname":"内科学"},{"id":"3783","name":"肝明显缩小的肝硬化类型是","data":{"A":"病毒性肝炎后肝硬化","B":"酒精性肝硬化","C":"淤血性肝硬化","D":"原发性胆汁性肝硬化"},"da_an":"A","typeid":"117","time":"2018-11-17 17:41:47","xiang_jie":"[考点还原]  八版内科学未明确说明。\r\n[解析]肝硬化是一种或多种病因长期或反复作用导致的肝组织弥漫性纤维化、再生结节和假小叶形成为特征的慢性肝病。慢性病毒性肝炎是我国肝硬化最常见的病因，原发性肝癌病人中约1/3有慢性病毒性肝炎史。所以在我国最易引起原发性肝癌的肝硬化类型是病毒性肝炎后肝硬化。肝明显缩小的肝硬化类型是病毒性肝炎后肝硬化。而其他类型的肝硬化（酒精性肝硬化、淤血性肝硬化和原发性胆汁性肝硬化）均为肝增大。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"435","all_num":"500","types":0,"pname":"内科学"},{"id":"3790","name":"消化性溃疡患者最常见的并发症是","data":{"A":"穿孔","B":"出血","C":"幽门梗阻","D":"癌变"},"da_an":"B","typeid":"117","time":"2018-09-13 15:12:59","xiang_jie":"[考点]消化性溃疡的并发症\r\n[考点还原]（七版内科学P391）\u201c出血（B对）是消化性溃疡最常见的并发症\u201d。                    [解析]消化性溃疡是指胃肠道黏膜被自身消化而形成的溃疡，常见并发症包括出血、穿孔、幽门梗阻和癌变，其中出血是消化性溃疡最常见的并发症。消化性溃疡又包括胃溃疡和十二指肠溃疡，十二指肠溃疡患者不易发生癌变并发症。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"460","all_num":"501","types":0,"pname":"内科学"},{"id":"3795","name":"十二指肠溃疡患者不易发生的并发症是","data":{"A":"穿孔","B":"出血","C":"幽门梗阻","D":"癌变"},"da_an":"D","typeid":"117","time":"2018-09-13 15:13:50","xiang_jie":"[考点]消化性溃疡的并发症                                                                                                        \r\n [考点还原]（P371）\u201c（四）癌变  溃疡由良性演变为恶性的几率很低，估计＜1％胃溃疡有可能癌变，十二指肠球部溃疡一般不发生癌变\u201d（D对）。\r\n[解析]消化性溃疡是指胃肠道黏膜被自身消化而形成的溃疡，常见并发症包括出血、穿孔、幽门梗阻和癌变，其中出血是消化性溃疡最常见的并发症。消化性溃疡又包括胃溃疡和十二指肠溃疡，十二指肠溃疡患者不易发生癌变并发症。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"483","all_num":"503","types":0,"pname":"内科学"},{"id":"3804","name":"侵入性检查幽门螺杆菌的首选方法是","data":{"A":"血清学检查","B":"13C尿素呼气试验","C":"胃组织学检查","D":"快速尿素酶试验"},"da_an":"D","typeid":"117","time":"2018-09-13 15:14:47","xiang_jie":"[考点]幽门螺杆菌的检查方法\r\n[考点还原]（七版内科学P533）\u201c快速尿素酶试验是侵入性检查的首选方法\u201d（C对）          \r\n [解析]幽门螺杆菌的检查方法有侵入性和非侵入性两类，其中侵入性方法包括快速尿素酶试验、胃组织学检查及细菌培养等，快速尿素酶试验是侵入性检查幽门螺杆菌的首选方法。当幽门螺杆菌根除治疗后复查疗效时，首选的检查方法是l3C尿素呼气试验，这是最常用的非侵入性检查幽门螺杆菌的方法，虽然血清学检查也是非侵入性检查幽门螺杆菌的方法，但由于该方法检查的是抗幽门螺杆菌的抗体，当幽门螺杆菌根除治疗后，幽门螺杆菌可能已被根除，但其抗体却不会随幽门螺杆菌根除而消失；另外当幽门螺杆菌根除治疗后复查疗效时，也不会选用侵入性检查幽门螺杆菌的方法。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"442","all_num":"510","types":0,"pname":"内科学"},{"id":"3807","name":"当幽门螺杆菌根除治疗后复查疗效时，首选的检查方法是","data":{"A":"血清学检查","B":"13C尿素呼气试验","C":"胃组织学检查","D":"快速尿素酶试验"},"da_an":"B","typeid":"117","time":"2018-08-06 11:06:11","xiang_jie":"[考点]幽门螺杆菌的检查方法                                                                                                     \r\n [考点还原]（七版内科学P533）\u201c¹³C或¹\u2074C尿素呼气试验检测幽门螺杆菌敏感性及特异性高而无需胃镜检查，可作为根除治疗后复查的首选方法\u201d（B对）。\r\n[解析]幽门螺杆菌的检查方法有侵入性和非侵入性两类，其中侵入性方法包括快速尿素酶试验、胃组织学检查及细菌培养等，快速尿素酶试验是侵入性检查幽门螺杆菌的首选方法。当幽门螺杆菌根除治疗后复查疗效时，首选的检查方法是l3C尿素呼气试验，这是最常用的非侵入性检查幽门螺杆菌的方法，虽然血清学检查也是非侵入性检查幽门螺杆菌的方法，但由于该方法检查的是抗幽门螺杆菌的抗体，当幽门螺杆菌根除治疗后，幽门螺杆菌可能已被根除，但其抗体却不会随幽门螺杆菌根除而消失；另外当幽门螺杆菌根除治疗后复查疗效时，也不会选用侵入性检查幽门螺杆菌的方法。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"483","all_num":"507","types":0,"pname":"内科学"},{"id":"3812","name":"克罗恩病患者最常见的并发症是","data":{"A":"肠穿孔","B":"肠出血","C":"肠梗阻","D":"中毒性巨结肠"},"da_an":"C","typeid":"117","time":"2018-09-13 15:15:46","xiang_jie":"[考点]炎症性肠病患者的并发症\r\n[考点还原]（P391）\u201c【并发症】 肠梗阻最常见，其次是腹腔内脓肿，偶可并发急性穿孔或大量便血\u201d（C对）。                                                                                                                   \r\n[解析]肠穿孔、肠出血、肠梗阻、中毒性巨结肠都是炎症性肠病的并发症，其中肠梗阻是克罗恩病患者最常见的并发症；中毒性巨结肠是暴发型或重型溃疡性结肠炎患者最易发生的并发症。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"446","all_num":"500","types":0,"pname":"内科学"},{"id":"3817","name":"暴发型或重型溃疡性结肠炎患者最易发生的并发症是","data":{"A":"肠穿孔","B":"肠出血","C":"肠梗阻","D":"中毒性巨结肠"},"da_an":"D","typeid":"117","time":"2018-09-13 15:16:15","xiang_jie":"[考点]炎症性肠病患者的并发症                                                                                                 \r\n [考点还原]（P387）\u201c（一）中毒性巨结肠  约5％的重症UC患者可出现中毒性巨结肠\u201d（D对）。\r\n[解析]肠穿孔、肠出血、肠梗阻、中毒性巨结肠都是炎症性肠病的并发症，其中肠梗阻是克罗恩病患者最常见的并发症；中毒性巨结肠是暴发型或重型溃疡性结肠炎患者最易发生的并发症。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"487","all_num":"505","types":0,"pname":"内科学"},{"id":"3821","name":"肝硬化代偿期的体征是","data":{"A":"黄疸","B":"肝大","C":"腹壁静脉曲张","D":"皮肤紫癜"},"da_an":"B","typeid":"117","time":"2018-09-13 15:17:23","xiang_jie":"[考点]肝硬化的临床表现\r\n[考点还原]（P421）\u201c（一）代偿期  大部分患者无症状或症状较轻，可有腹部不适、乏力、食欲减退、消化不良和腹泻等症状\u2026肝脏是否肿大取决于不同类型的肝硬化（B对）\u201d。（P421）\u201c（二）失代偿期 （3）黄疸（A错）\u2026（4）出血和贫血：常有鼻腔、牙龈出血及皮肤黏膜瘀点、瘀斑和消化道出血等（D错）\u201d。（P422）\u201c②腹壁静脉曲张\u201d（C错）。    \r\n [解析]肝硬化分为代偿期和失代偿期。肝硬化代偿期是肝硬化的早期阶段，可触及肿大的肝，即肝大。其余备选答案均为肝硬化失代偿期的表现，其中只有腹壁静脉曲张为肝硬化失代偿期门静脉高压的体征。黄疸提示肝功能储备已明显减退；皮肤紫癜为出血倾向，主要与肝合成凝血因子减少及脾功能亢进所致血小板减少有关。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"403","all_num":"502","types":0,"pname":"内科学"},{"id":"3827","name":"肝硬化失代偿期门脉高压的体征是","data":{"A":"黄疸","B":"肝大","C":"腹壁静脉曲张","D":"皮肤紫癜"},"da_an":"C","typeid":"117","time":"2018-09-13 15:18:06","xiang_jie":"[考点]肝硬化的临床表现                                                                                                            [考点还原]（P422）\u201c②腹壁静脉曲张\u201d（C对）。\r\n[解析]肝硬化分为代偿期和失代偿期。肝硬化代偿期是肝硬化的早期阶段，可触及肿大的肝，即肝大。其余备选答案均为肝硬化失代偿期的表现，其中只有腹壁静脉曲张为肝硬化失代偿期门静脉高压的体征。黄疸提示肝功能储备已明显减退；皮肤紫癜为出血倾向，主要与肝合成凝血因子减少及脾功能亢进所致血小板减少有关。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"485","all_num":"488","types":0,"pname":"内科学"},{"id":"3831","name":"肝性脑病二期的表现是","data":{"A":"扑翼样震颤无法引出","B":"轻度性格改变和行为失常","C":"昏睡和精神错乱","D":"意识错乱和睡眠倒错"},"da_an":"D","typeid":"117","time":"2018-09-13 15:18:46","xiang_jie":"[考点]肝性脑病的临床表现\r\n[考点还原]（P435）\u201c1期（前驱期） 轻度性格改变和精神异常\u201d（B错）。（P435）\u201c2期（昏迷前期）嗜睡、行为异常（如衣冠不整或随地大小便）、言语不清、书写障碍及定向力障碍\u201d（D对）。（P435）\u201c3期（昏睡期） 昏睡，但可唤醒，醒时尚能作答，常有神志不清或幻觉\u201d（C错）。（P435）\u201c4期（昏迷期） 昏迷，不能唤醒。患者不能合作而无法引出扑翼样震颤\u201d（A错）。                                                                                                                   \r\n [解析]根据肝性脑病的临床表现，肝性脑病分为四期：一期（前驱期）表现为轻度性格改变和行为失常，可引出扑翼样震颤；二期（昏迷前期）表现为意识错乱和睡眠倒错，可引出扑翼样震颤；三期（昏睡期）表现为昏睡和精神错乱，仍可引出扑翼样震颤；四期（昏迷期）扑翼样震颤无法引出。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"404","all_num":"497","types":0,"pname":"内科学"},{"id":"3838","name":"肝性脑病四期的表现是","data":{"A":"扑翼样震颤无法引出","B":"轻度性格改变和行为失常","C":"昏睡和精神错乱","D":"意识错乱和睡眠倒错"},"da_an":"A","typeid":"117","time":"2018-09-13 15:19:23","xiang_jie":"[考点]肝性脑病的临床表现                                                                                                         \r\n[考点还原]（P435）\u201c1期（前驱期） 轻度性格改变和精神异常\u201d（B错）。（P435）\u201c2期（昏迷前期） 嗜睡、行为异常（如衣冠不整或随地大小便）、言语不清、书写障碍及定向力障碍\u201d（D错）。（P435）\u201c3期（昏睡期） 昏睡，但可唤醒，醒时尚能作答，常有神志不清或幻觉\u201d（C错）。（P435）\u201c4期（昏迷期） 昏迷，不能唤醒。患者不能合作而无法引出扑翼样震颤\u201d（A对）。\r\n[解析]根据肝性脑病的临床表现，肝性脑病分为四期：一期（前驱期）表现为轻度性格改变和行为失常，可引出扑翼样震颤；二期（昏迷前期）表现为意识错乱和睡眠倒错，可引出扑翼样震颤；三期（昏睡期）表现为昏睡和精神错乱，仍可引出扑翼样震颤；四期（昏迷期）扑翼样震颤无法引出。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"467","all_num":"501","types":0,"pname":"内科学"},{"id":"3845","name":"治疗肝性脑病时，可减少假神经递质形成的药物是：","data":{"A":"精氨酸","B":"谷氨酸钾","C":"支链氨基酸","D":"乳果糖"},"da_an":"C","typeid":"117","time":"2018-08-06 11:14:41","xiang_jie":"[考点]肝性脑病的治疗\r\n[考点还原]（P436-P437）\u201c（三）减少肠内氮源性毒物的生成与吸收\u20262.乳果糖（D错）或乳梨醇\u201d。（P437）\u201c（四）促进体内氨的代谢\u20263.其他  谷氨酸钠或钾（B错）、精氨酸（A错）等药物理论上具有降血氨作用\u201d。（P437）\u201c2.减少或拮抗假性神经递质  支链氨基酸（C对）制剂是一种以亮氨酸、异亮氨酸、缬氨酸等为主的复合氨基酸。其机制为竞争性抑制芳香族氨基酸进入大脑，减少假性神经递质的形成\u201d。                                                               \r\n [解析]支链氨基酸制剂是一种以亮氨酸、异亮氨酸、缬氨酸为主的复合氨基酸，可竞争性抑制芳香族氨基酸进入大脑，减少假神经递质的形成。乳果糖在结肠可被乳酸杆菌、粪肠球菌等细菌分解成乳酸、乙酸而降低肠道的pH值，肠道酸化后对产尿素酶的细菌生长不利，但有利于不产尿素酶的乳酸杆菌生长，使肠道细菌产氨减少；酸性的肠道环境可减少氨的吸收，并促进血液中的氨渗入肠道排出。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"383","all_num":"519","types":0,"pname":"内科学"},{"id":"3851","name":"治疗肝性脑病时，可减少氨生成与吸收的药物是：","data":{"A":"精氨酸","B":"谷氨酸钾","C":"支链氨基酸","D":"乳果糖"},"da_an":"D","typeid":"117","time":"2018-09-13 15:20:26","xiang_jie":"[考点]肝性脑病的治疗                                                                                                                \r\n [考点还原]（P436-P437）\u201c（三）减少肠内氮源性毒物的生成与吸收\u20262.乳果糖或乳梨醇  乳果糖是一种合成的双糖，口服后在小肠不被分解，到达结肠后可被乳酸杆菌、粪肠球菌等细菌分解为乳酸、乙酸而降低肠道的pH值。肠道酸化后对产尿素酶的细菌生长不利，但有利于不产尿素酶的乳酸杆菌生长，使肠道细菌产氨减少；此外，酸性的肠道环境可减少氨的吸收，并促进血液中的氨渗入肠道排出体外\u201d（D对）。（P437）\u201c2.减少或拮抗假性神经递质  支链氨基酸（C错）制剂是一种以亮氨酸、异亮氨酸、缬氨酸等为主的复合氨基酸。其机制为竞争性抑制芳香族氨基酸进入大脑，减少假性神经递质的形成\u201d。（P437）\u201c（四）促进体内氨的代谢\u2026谷氨酸钠或钾（B错）、精氨酸（A错）等药物理论上具有降血氨作用\u201d。\r\n[解析]支链氨基酸制剂是一种以亮氨酸、异亮氨酸、缬氨酸为主的复合氨基酸，可竞争性抑制芳香族氨基酸进入大脑，减少假神经递质的形成。乳果糖在结肠可被乳酸杆菌、粪肠球菌等细菌分解成乳酸、乙酸而降低肠道的pH值，肠道酸化后对产尿素酶的细菌生长不利，但有利于不产尿素酶的乳酸杆菌生长，使肠道细菌产氨减少；酸性的肠道环境可减少氨的吸收，并促进血液中的氨渗入肠道排出。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"335","all_num":"552","types":0,"pname":"内科学"},{"id":"3857","name":"夜间痛多见且易并发出血的溃疡是","data":{"A":"无症状性溃疡","B":"幽门管溃疡","C":"复合性溃疡","D":"球后溃疡"},"da_an":"D","typeid":"117","time":"2018-09-13 15:21:12","xiang_jie":"[考点]四种特殊类型消化性溃疡的特点\r\n[考点还原]（七版内科学P390）\u201c（三）球后溃疡\u2026具有DU的临床特点，但午夜痛及背部放射痛多见，对药物治疗反应较差，较易并发出血\u201d（D对）。                                                 \r\n[解析]球后溃疡多发生在十二指肠乳头的近端，其临床特点是夜间痛多见且易并发出血，所以夜间痛多见且易并发出血的溃疡是球后溃疡；约15%消化性溃疡患者临床可无症状，称为无症状性溃疡，以老年人多见，NSAID引起的溃疡近半数无症状，用H2RA维持治疗过程中，复发的溃疡半数以上也是无症状性溃疡。而幽门管溃疡发生在胃远端，较易发生幽门梗阻、出血和穿孔等并发症；复合性溃疡是指胃和十二指肠同时发生的溃疡，幽门梗阻发生率较高。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"482","all_num":"543","types":0,"pname":"内科学"},{"id":"3861","name":"用H2RA维持治疗过程中，复发的溃疡半数以上是","data":{"A":"无症状性溃疡","B":"幽门管溃疡","C":"复合性溃疡","D":"球后溃疡"},"da_an":"A","typeid":"117","time":"2018-09-13 15:21:54","xiang_jie":"[考点]四种特殊类型消化性溃疡的特点                                                                                     \r\n[考点还原]（五版内科学P403）\u201c用H\u2082受体拮抗剂（H\u2082RA）维持治疗中复发的溃疡半数以上为无症状溃疡\u201d（A对）。\r\n[解析]球后溃疡多发生在十二指肠乳头的近端，其临床特点是夜间痛多见且易并发出血，所以夜间痛多见且易并发出血的溃疡是球后溃疡；约15%消化性溃疡患者临床可无症状，称为无症状性溃疡，以老年人多见，NSAID引起的溃疡近半数无症状，用H2RA维持治疗过程中，复发的溃疡半数以上也是无症状性溃疡。而幽门管溃疡发生在胃远端，较易发生幽门梗阻、出血和穿孔等并发症；复合性溃疡是指胃和十二指肠同时发生的溃疡，幽门梗阻发生率较高。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"282","all_num":"575","types":0,"pname":"内科学"},{"id":"3866","name":"治疗轻、中型溃疡性结肠炎的首选药物是","data":{"A":"柳氮磺吡啶","B":"美沙拉嗪","C":"布地奈德","D":"硫唑嘌呤"},"da_an":"A","typeid":"117","time":"2018-09-13 15:23:22","xiang_jie":"[考点]炎症性肠病（溃疡性结肠炎和克罗恩病）的治疗\r\n[考点还原]（P389）\u201c（1）柳氮磺吡啶（SASP）：治疗轻、中度或经糖皮质激素治疗已有缓解的重度UC常用药物\u201d（A对）                                                                                              \r\n[解析]溃疡性结肠炎和克罗恩病均属于炎症性肠病。溃疡性结肠炎是一种病因尚不十分清楚的直肠和结肠慢性非特异性炎症性疾病，治疗轻、中型溃疡性结肠炎的首选药物是柳氮磺吡啶，柳氮磺吡啶口服后，经肠菌分解为5-氨基水杨酸（5-ASA）发挥作用，也可用于重型经糖皮质激素治疗已有缓解者。克罗恩病是一种病因尚不十分清楚的肠道慢性炎性肉芽肿性疾病，病变多见于远端回肠和结肠，美沙拉嗪是5-ASA的新型制剂，口服能达到远端回肠和结肠，在此定位释放而发挥作用，因此是治疗轻、中型克罗恩病（病变累及回肠和结肠）的首选药物，由于美沙拉嗪价格昂贵，不作为治疗轻、中型溃疡性结肠炎的首选药物。布地奈德属于新型的糖皮质激素，硫唑嘌呤属于免疫抑制剂.均不是治疗轻、中型溃疡性结肠炎和轻、中型克罗恩病（病变累及回肠和结肠）的首选药物。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"470","all_num":"555","types":0,"pname":"内科学"},{"id":"3870","name":"治疗轻、中型克罗恩病（病变累及回肠和结肠）的首选药物是","data":{"A":"柳氮磺吡啶","B":"美沙拉嗪","C":"布地奈德","D":"硫唑嘌呤"},"da_an":"B","typeid":"117","time":"2018-09-13 15:23:56","xiang_jie":"[考点]炎症性肠病（溃疡性结肠炎和克罗恩病）的治疗                                                          [考点还原]（P392）\u201c（一）控制炎症反应  1.活动期 （1）5-ASA：SASP仅适用于病变局限在结肠的轻度患者（A错）；美沙拉嗪能在回肠末端、结肠定位释放，适用于轻度回结肠型及轻度结肠型患者（B对）\u201d。\r\n[解析]溃疡性结肠炎和克罗恩病均属于炎症性肠病。溃疡性结肠炎是一种病因尚不十分清楚的直肠和结肠慢性非特异性炎症性疾病，治疗轻、中型溃疡性结肠炎的首选药物是柳氮磺吡啶，柳氮磺吡啶口服后，经肠菌分解为5-氨基水杨酸（5-ASA）发挥作用，也可用于重型经糖皮质激素治疗已有缓解者。克罗恩病是一种病因尚不十分清楚的肠道慢性炎性肉芽肿性疾病，病变多见于远端回肠和结肠，美沙拉嗪是5-ASA的新型制剂，口服能达到远端回肠和结肠，在此定位释放而发挥作用，因此是治疗轻、中型克罗恩病（病变累及回肠和结肠）的首选药物，由于美沙拉嗪价格昂贵，不作为治疗轻、中型溃疡性结肠炎的首选药物。布地奈德属于新型的糖皮质激素，硫唑嘌呤属于免疫抑制剂.均不是治疗轻、中型溃疡性结肠炎和轻、中型克罗恩病（病变累及回肠和结肠）的首选药物。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"407","all_num":"575","types":0,"pname":"内科学"},{"id":"3875","name":"自身免疫性胃炎的胃酸分泌","data":{"A":"缺乏","B":"正常或减少","C":"少量增加","D":"明显增加"},"da_an":"A","typeid":"117","time":"2018-09-13 15:24:54","xiang_jie":"[考点]慢性萎缩性胃炎的胃酸分泌情况\r\n[考点还原]（P365）\u201c当体内出现针对壁细胞或内因子的自身抗体时，作为靶细胞的壁细胞总数减少，胃酸分泌降低\u201d（A对）。                                                                                        \r\n[解析]慢性萎缩性胃炎包括自身免疫性胃炎和多灶萎缩性胃炎两大类，自身免疫性胃炎又称胃体胃炎（A塑胃炎），萎缩改变主要位于胃体部，当胃体黏膜出现明显萎缩时，胃液分析显示胃酸分泌缺乏；多灶萎缩性胃炎又称胃窦胃炎（B型胃炎），胃液分析显示胃酸分泌正常或减少；胃酸分泌增加见于十二指肠溃疡和胃泌素瘤。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"394","all_num":"554","types":0,"pname":"内科学"},{"id":"3880","name":"多灶萎缩性胃炎的胃酸分泌","data":{"A":"缺乏","B":"正常或减少","C":"少量增加","D":"明显增加"},"da_an":"B","typeid":"117","time":"2018-09-13 15:25:32","xiang_jie":"[考点]慢性萎缩性胃炎的胃酸分泌情况                                                                                     \r\n[考点还原]  八版内科学未明确说明。\r\n[解析]慢性萎缩性胃炎包括自身免疫性胃炎和多灶萎缩性胃炎两大类，自身免疫性胃炎又称胃体胃炎（A塑胃炎），萎缩改变主要位于胃体部，当胃体黏膜出现明显萎缩时，胃液分析显示胃酸分泌缺乏；多灶萎缩性胃炎又称胃窦胃炎（B型胃炎），胃液分析显示胃酸分泌正常或减少；胃酸分泌增加见于十二指肠溃疡和胃泌素瘤。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"470","all_num":"538","types":0,"pname":"内科学"},{"id":"3883","name":"重度胃体萎缩型胃炎","data":{"A":"胃液酸度升高","B":"胃液酸度正常或减少","C":"胃液酸度常减少","D":"胃液酸度明显升高","E":"胃液酸度明显减少"},"da_an":"E","typeid":"117","time":"2018-09-13 15:26:24","xiang_jie":"[考点]胃肠疾病与胃液酸度改变\r\n[考点还原]  八版内科学未明确说明。                                                                                    \r\n[解析]胃酸是由胃体壁细胞分泌的，当重度胃体萎缩型胃炎时产生胃酸的壁细胞明敁抑制，故胃液酸度应明显减少；而壁细胞上有胃泌素受体，故当胃泌素瘤时，会因分泌大量胃泌素刺激胃壁细胞产生大量胃酸，结果使胃液酸度明显升高。其他几项中，胃液酸度升高见于十二指肠溃疡；胃液酸度正常或减少见于胃溃疡；重度胃窦萎缩型胃炎的胃液酸度常减少。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"362","all_num":"557","types":0,"pname":"内科学"},{"id":"3891","name":"胃泌素瘤：","data":{"A":"胃液酸度升高","B":"胃液酸度正常或减少","C":"胃液酸度常减少","D":"胃液酸度明显升高","E":"胃液酸度明显减少"},"da_an":"D","typeid":"117","time":"2018-09-13 15:26:56","xiang_jie":"[考点]胃肠疾病与胃液酸度改变                                                                                                 \r\n [考点还原]（P372）\u201c（三）Zollinger-Ellison 综合征\u2026该综合征由促胃液素瘤或促胃液素细胞增生所致，临床以高胃酸分泌，血促胃液素水平升高，多发、顽固及不典型部位消化性溃疡及腹泻为特征\u201d（七版内科学P391）\u201c（二）胃泌素瘤  亦称Zollinger-Ellison 综合征，是胰腺非β细胞瘤分泌大量胃泌素所致。肿瘤往往很小（＜1cm），生长缓慢，半数为恶性。大量胃泌素可刺激壁细胞增生，分泌大量胃酸\u201d（D对）。\r\n[解析]胃酸是由胃体壁细胞分泌的，当重度胃体萎缩型胃炎时产生胃酸的壁细胞明敁抑制，故胃液酸度应明显减少；而壁细胞上有胃泌素受体，故当胃泌素瘤时，会因分泌大量胃泌素刺激胃壁细胞产生大量胃酸，结果使胃液酸度明显升高。其他几项中，胃液酸度升高见于十二指肠溃疡；胃液酸度正常或减少见于胃溃疡；重度胃窦萎缩型胃炎的胃液酸度常减少。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"408","all_num":"532","types":0,"pname":"内科学"},{"id":"3896","name":"胃溃疡穿孔","data":{"A":"右上腹绞痛，伴压痛、黄疸，Murphy征阳性","B":"脐周围阵痛，伴有压痛、肠鸣音亢进，有肠型","C":"上腹压痛，板样强直，肝浊音界消失","D":"上腹部胀痛，伴有胃型及拍水声","E":"胸骨下持续性钝痛，腹部体征正常"},"da_an":"C","typeid":"117","time":"2018-09-13 15:27:46","xiang_jie":"[考点]不同胃肠疾病腹痛特点\r\n[考点还原]（P355）\u201c病人突发上腹部剧痛，呈\u2018刀割样\u2019，腹痛迅速波及全腹\u2026体检见病人表情痛苦，取屈曲体位，不敢移动。腹式呼吸减弱或消失，全腹压痛，但以穿孔处最重。腹肌紧张呈\u2018板状腹\u2019，反跳痛明显。肠鸣音减弱或消失。叩诊肝浊音界缩小或消失，可闻移动性浊音\u201d（C对）。                                                                                                                           \r\n[解析]胃溃疡穿孔时可致急性腹膜炎，并有气体进入腹腔，故表现为上腹压痛，板样强直，肝浊音界消失；急性肠梗阻时则因肠道与外界不通，肠内压增高，引起脐周围阵痛，伴有压痛，肠鸣音亢进，有肠型。其他几项中，右上腹绞痛，伴压痛、黄疸、Murphy征阳性显然是胆石症及急性胆囊炎；上腹部胀痛伴有胃型及拍水声见于幽门梗阻；胸骨下持续性钝痛，腹部体征正常见于急性心肌梗死。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"469","all_num":"515","types":0,"pname":"内科学"},{"id":"3901","name":"急性肠梗阻","data":{"A":"右上腹绞痛，伴压痛、黄疸，Murphy征阳性","B":"脐周围阵痛，伴有压痛、肠鸣音亢进，有肠型","C":"上腹部胀痛，伴有胃型及拍水声","D":"胸骨下持续性钝痛，腹部体征正常"},"da_an":"B","typeid":"117","time":"2018-09-13 15:28:26","xiang_jie":"[考点]不同胃肠疾病腹痛特点                                                                                                     \r\n[考点还原]（P375）\u201c腹部视诊：机械性肠梗阻常可见肠型和蠕动波。肠扭转时腹胀多不对称；麻痹性肠梗阻\u2026肠鸣音亢进，有气过水声或金属音，为机械性肠梗阻表现。麻痹性肠梗阻时，则肠鸣音减弱或消失\u201d（B对）。\r\n[解析]胃溃疡穿孔时可致急性腹膜炎，并有气体进入腹腔，故表现为上腹压痛，板样强直，肝浊音界消失；急性肠梗阻时则因肠道与外界不通，肠内压增高，引起脐周围阵痛，伴有压痛，肠鸣音亢进，有肠型。其他几项中，右上腹绞痛，伴压痛、黄疸、Murphy征阳性显然是胆石症及急性胆囊炎；上腹部胀痛伴有胃型及拍水声见于幽门梗阻；胸骨下持续性钝痛，腹部体征正常见于急性心肌梗死。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"439","all_num":"522","types":0,"pname":"内科学"},{"id":"3905","name":"酸泵抑制剂：","data":{"A":"丙谷胺","B":"前列腺素E2的衍生物","C":"奥美拉唑（Omeprazole）","D":"派吡氮平","E":"吗丁啉（多潘立酮）"},"da_an":"C","typeid":"117","time":"2018-09-13 15:29:23","xiang_jie":"[考点]消化性溃疡的治疗\r\n[考点还原]（P373）\u201c表4-5-4  常用的各种PPI\u201d（C对ABDE错）。                                         \r\n[解析]奥美拉唑（Omeprazole）能抑制H+/K＋-ATP酶的活力，因而是酸泵抑制剂；前列腺素E2的衍生物可加强黏膜对损伤的抵抗力，因而是黏膜细胞保护剂。而丙谷胺是抗胃泌素药；派吡氮平是抗胆碱能药；吗丁啉（多潘立酮）是胃动力药。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"489","all_num":"499","types":0,"pname":"内科学"},{"id":"3908","name":"黏膜细胞保护剂","data":{"A":"丙谷胺","B":"前列腺素E2的衍生物","C":"奥美拉唑（Omeprazole）","D":"派吡氮平","E":"吗丁啉（多潘立酮）"},"da_an":"B","typeid":"117","time":"2018-09-13 15:30:22","xiang_jie":"[考点]消化性溃疡的治疗                                                                                                            \r\n[考点还原]（七版内科学P392）\u201c表4-5-1\u201d。（七版内科学P393）\u201c2、保护胃黏膜药物\u2026米索前列醇具有抑制胃酸分泌、增加胃十二指肠黏膜的黏液及碳酸氢盐分泌和增加黏膜血流等作用\u201d（B对）。\r\n[解析]奥美拉唑（Omeprazole）能抑制H+/K＋-ATP酶的活力，因而是酸泵抑制剂；前列腺素E2的衍生物可加强黏膜对损伤的抵抗力，因而是黏膜细胞保护剂。而丙谷胺是抗胃泌素药；派吡氮平是抗胆碱能药；吗丁啉（多潘立酮）是胃动力药。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"484","all_num":"511","types":0,"pname":"内科学"},{"id":"3911","name":"胃泌素产生于：","data":{"A":"壁细胞","B":"主细胞","C":"黏液细胞","D":"G细胞","E":"肥大细胞"},"da_an":"D","typeid":"117","time":"2018-09-13 15:30:56","xiang_jie":"[考点]消化性溃疡的发病机制\r\n[考点还原]（P199）\u201c促胃液素是由胃窦及十二指肠和空肠上段黏膜中G细胞分泌的一种胃肠激素\u201d                                                                                                                                         [解析]胃泌素是由G细胞产生的；胃蛋白酶原是由主细胞产生的。其他细胞分别产生其他物质：如壁细胞产生胃酸和内因子；黏液细胞产生碱性黏液；肥大细胞产生组胺。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"397","all_num":"537","types":0,"pname":"内科学"},{"id":"3913","name":"胃蛋白酶原产生于","data":{"A":"壁细胞","B":"主细胞","C":"黏液细胞","D":"G细胞","E":"肥大细胞"},"da_an":"B","typeid":"117","time":"2018-09-13 15:31:42","xiang_jie":"[考点]消化性溃疡的发病机制                                                                                                     \r\n[考点还原]（P196）\u201c胃蛋白酶原主要由胃泌酸腺的主细胞（B对）合成和分泌。颈黏液细胞、贲门腺和幽门腺的黏液细胞（C对）以及十二指肠近端的腺体也能分泌胃蛋白酶原\u201d。\r\n[解析]胃泌素是由G细胞产生的；胃蛋白酶原是由主细胞产生的。其他细胞分别产生其他物质：如壁细胞产生胃酸和内因子；黏液细胞产生碱性黏液；肥大细胞产生组胺。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"448","all_num":"563","types":0,"pname":"内科学"},{"id":"3916","name":"解除有机磷中毒时烟碱样毒性作用，首选","data":{"A":"阿托品","B":"解磷定","C":"美解眠（贝美格）","D":"尼可刹米","E":"甘露醇"},"da_an":"B","typeid":"117","time":"2018-09-13 15:33:53","xiang_jie":"[考点]有机磷中毒的治疗\r\n[考点还原]（P886）\u201c2.ChE复能药\u2026ChE复能药尚能作用于外周N\u2082受体，对抗外周N胆碱受体活性，能有效解除烟碱样毒性作用，对M样症状和中枢性呼吸抑制作用无明显影响。所用药物如下：（1）氯解磷定（B对）\u201d。（P888）\u201c（1）M胆碱受体阻断药：又称外周性抗胆碱能药。阿托品（A错）和山莨菪碱等主要作用于外周M受体，能缓解M样症状，对N受体无明显作用\u201d。[解析]有机磷中毒时，烟碱样毒性作用是由于胆碱酯酶失活后乙酰胆碱过度蓄积和刺激所致，解磷定是胆碱酯酶复能剂，可恢复胆碱酯酶活力，从而分解乙酰胆碱而发挥治疗作用；阿托品可阻断副交感神经的毒蕈碱样作用，而对烟碱样作用无效。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"389","all_num":"530","types":0,"pname":"内科学"},{"id":"3919","name":"解除有机磷中毒时毒蕈碱样毒性作用，首选","data":{"A":"阿托品","B":"解磷定","C":"美解眠（贝美格","D":"尼可刹米","E":"甘露醇"},"da_an":"A","typeid":"117","time":"2018-09-13 15:34:37","xiang_jie":"[考点]有机磷中毒的治疗                                                                                                            \r\n[考点还原]（P886）\u201c2.ChE复能药\u2026ChE复能药尚能作用于外周N\u2082受体，对抗外周N胆碱受体活性，能有效解除烟碱样毒性作用，对M样症状和中枢性呼吸抑制作用无明显影响。所用药物如下：（1）氯解磷定（B错）\u201d。（P888）\u201c（1）M胆碱受体阻断药：又称外周性抗胆碱能药。阿托品（A对）和山莨菪碱等主要作用于外周M受体，能缓解M样症状，对N受体无明显作用\u201d。\r\n[解析]有机磷中毒时，烟碱样毒性作用是由于胆碱酯酶失活后乙酰胆碱过度蓄积和刺激所致，解磷定是胆碱酯酶复能剂，可恢复胆碱酯酶活力，从而分解乙酰胆碱而发挥治疗作用；阿托品可阻断副交感神经的毒蕈碱样作用，而对烟碱样作用无效。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"424","all_num":"495","types":0,"pname":"内科学"},{"id":"3924","name":"吗丁啉（多潘立酮）","data":{"A":"促进胃排空，增强胃窦和十二指肠运动","B":"减少胃酸和胃蛋白酶分泌","C":"促进胃黏膜血流，刺激胃黏液分泌","D":"防止氢离子反渗，促进胃黏液分泌","E":"减少胃酸分泌，延缓胃排空"},"da_an":"A","typeid":"117","time":"2018-09-13 15:35:14","xiang_jie":"[考点]胃炎和消化性溃疡的治疗\r\n[考点还原]（P359）\u201c促胃肠动力药  如多潘立酮\u201d（A对）。                                                  \r\n[解析]吗丁啉（多潘立酮）是一种胃动力药，因而可促进胃排空及增强胃窦和十二指肠运动；生胃酮（甘珀酸）是自甘草中提取的甘草酸经水解衍化而来，能防止氢离子反渗和促进胃黏液分泌。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"503","all_num":"533","types":0,"pname":"内科学"},{"id":"3929","name":"生胃酮（甘珀酸）","data":{"A":"促进胃排空，增强胃窦和十二指肠运动","B":"减少胃酸和胃蛋白酶分泌","C":"促进胃黏膜血流，刺激胃黏液分泌","D":"防止氢离子反渗，促进胃黏液分泌","E":"减少胃酸分泌，延缓胃排空"},"da_an":"D","typeid":"117","time":"2018-09-13 15:35:58","xiang_jie":"[考点]胃炎和消化性溃疡的治疗                                                                                                 \r\n[考点还原]  八版内科学未明确说明。\r\n[解析]吗丁啉（多潘立酮）是一种胃动力药，因而可促进胃排空及增强胃窦和十二指肠运动；生胃酮（甘珀酸）是自甘草中提取的甘草酸经水解衍化而来，能防止氢离子反渗和促进胃黏液分泌。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"275","all_num":"553","types":0,"pname":"内科学"},{"id":"3933","name":"B胃炎伴大量G细胞丧失","data":{"A":"胃酸度升高","B":"胃酸度正常或减少","C":"胃酸度常减少","D":"胃酸度明显升高","E":"胃酸度明显减少"},"da_an":"C","typeid":"117","time":"2018-10-11 19:33:40","xiang_jie":"[考点]胃炎和消化性溃疡的胃液分析\r\n \r\n[考点还原]  八版内科学未明确说明。                                                                                    \r\n [解析]B型胃炎不影响胃酸分泌，但有大量G细胞丧失时则胃酸度常减少；胃溃疡的胃酸分泌在正常范围内，亦可减少。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"263","all_num":"594","types":0,"pname":"内科学"},{"id":"3937","name":"胃溃疡","data":{"A":"胃酸度升高","B":"胃酸度正常或减少","C":"胃酸度常减少","D":"胃酸度明显升高","E":"胃酸度明显减少"},"da_an":"B","typeid":"117","time":"2018-09-13 15:37:12","xiang_jie":"[考点]胃炎和消化性溃疡的胃液分析                                                                                         \r\n[考点还原]（七版内科学P388）\u201cGU患者基础酸排量（BAO）及MAO多属正常或偏低，对此，可能解释为GU患者多伴多灶萎缩性胃炎，因为胃体壁细胞泌酸功能已受影响\u201d（B对）。\r\n[解析]B型胃炎不影响胃酸分泌，但有大量G细胞丧失时则胃酸度常减少；胃溃疡的胃酸分泌在正常范围内，亦可减少。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"390","all_num":"561","types":0,"pname":"内科学"},{"id":"3943","name":"引起胰腺细胞坏死的是","data":{"A":"胰蛋白酶","B":"糜蛋白酶","C":"弹力蛋白酶","D":"磷脂酶A","E":"激肽酶"},"da_an":"D","typeid":"117","time":"2018-09-13 15:37:53","xiang_jie":"[考点]急性胰腺炎的发病机制\r\n[考点还原]（七版内科学P470）\u201c磷脂酶A\u2082在小量胆酸参与下分解细胞膜的磷脂（D对），产生溶血磷脂酰胆碱和溶血脑磷脂，其细胞毒作用引起胰实质凝固性坏死、脂肪组织坏死及溶血\u201d。                                                                                                                                         \r\n [解析]这是两道记忆题，引起胰腺细胞坏死的是磷脂酶A；引起胰腺血管坏死的是弹力蛋白酶。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"340","all_num":"563","types":0,"pname":"内科学"},{"id":"3947","name":"引起胰腺血管坏死的是：","data":{"A":"胰蛋白酶","B":"糜蛋白酶","C":"弹力蛋白酶","D":"磷脂酶A","E":"激肽酶"},"da_an":"C","typeid":"117","time":"2018-09-13 15:38:36","xiang_jie":"[考点]急性胰腺炎的发病机制                                                                                                     \r\n[考点还原]（七版内科学P470）\u201c弹性蛋白酶可溶解血管弹性纤维引起出血和血栓形成\u201d（C对）。\r\n[解析]这是两道记忆题，引起胰腺细胞坏死的是磷脂酶A；引起胰腺血管坏死的是弹力蛋白酶。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"502","all_num":"560","types":0,"pname":"内科学"},{"id":"3953","name":"胆红素生成过多见于","data":{"A":"Gilbert综合征","B":"无效造血","C":"Dubin-Johnson综合征","D":"Crigler-Najjar综合征","E":"Rotor综合征"},"da_an":"B","typeid":"117","time":"2018-09-13 15:39:16","xiang_jie":"[考点]黄疸的发生机制\r\n[考点还原]（八版诊断学P38）\u201cGlbert综合征Dubin-Johnson综合征（A错）：系由肝细胞摄取UCB功能障碍及微粒体内葡萄糖醛酸转移酶不足，致血中UCB增高而出现黄疸\u201d。（八版诊断学P38）\u201cDubin-Johnson综合征（C错）：系由肝细胞对CB及某些阴离子向毛细胆管排泄发生障碍，致血清CB增加而发生的黄疸\u201d。 （八版诊断学P38-P39） \u201cCrigler-najjar综合征（D错）：系由肝细胞缺乏葡萄糖醛酸转移酶，致UCB不能形成CB，导致血中UCB增多而出现黄疸\u201d。（八版诊断学P39）\u201cRotor综合征（E错）：系由肝细胞对摄取UCB和排泄CB存在先天性缺陷致血中胆红素增高而出现黄疸\u201d。                                                                   \r\n[解析]无效造血是骨髓内的原位溶血，由于溶血则可使胆红素生成过多；Dubin-Johnson综合征是肝细胞向毛细胆管排泄结合胆红素障碍，而胆红素的摄取和结合正常：Gilbert综合征是因肝细胞摄取游离胆红素障碍及微粒体内葡萄糖醛酸转移酶不足所致；Grigler-Najjar综合征是由于肝细胞缺乏葡萄糖醛酸转移酶，致不能形成结合胆红素，使血中非结合胆红素浓度增高；Rotor综合征是肝细胞摄取游离胆红素和排泄结合胆红素均有先天性缺陷，致血中结合胆红素增高为主。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"220","all_num":"532","types":0,"pname":"内科学"},{"id":"3961","name":"肝细胞向毛细胆管排泄结合胆红素障碍，而胆红素的摄取和结合正常见于","data":{"A":"Gilbert综合征","B":"无效造血","C":"Dubin-Johnson综合征","D":"Crigler-Najjar综合征","E":"Rotor综合征"},"da_an":"C","typeid":"117","time":"2018-09-13 15:39:56","xiang_jie":"[考点]黄疸的发生机制                                                                                                            \r\n[考点还原]（八版诊断学P38）\u201cGlbert综合征（A错）：系由肝细胞摄取UCB功能障碍及微粒体内葡萄糖醛酸转移酶不足，致血中UCB增高而出现黄疸\u201d。（八版诊断学P38）\u201cDubin-Johnson综合征（C对）：系由肝细胞对CB及某些阴离子向毛细胆管排泄发生障碍，致血清CB增加而发生的黄疸\u201d。（八版诊断学P38-P39P38）\u201cGlbert综合征（A错）：系由肝细胞摄取UCB功能障碍及微粒体内葡萄糖醛酸转移酶不足，致血中UCB增高而出现黄疸\u201d。（八版诊断学P38）\u201cDubin-Johnson综合征（C对）：系由肝细胞对CB及某些阴离子向毛细胆管排泄发生障碍，致血清CB增加而发生的黄疸\u201d。（八版诊断学P38-P39）\u201cCrigler-najjar综合征（D错）：系由肝细胞缺乏葡萄糖醛酸转移酶，致UCB不能形成CB，导致血中UCB增多而出现黄疸\u201d。（八版诊断学P39）\u201cRotor综合征（E错）：系由肝细胞对摄取UCB和排泄CB存在先天性缺陷致血中胆红素增高而出现黄疸\u201d。\r\n[解析]无效造血是骨髓内的原位溶血，由于溶血则可使胆红素生成过多；Dubin-Johnson综合征是肝细胞向毛细胆管排泄结合胆红素障碍，而胆红素的摄取和结合正常：Gilbert综合征是因肝细胞摄取游离胆红素障碍及微粒体内葡萄糖醛酸转移酶不足所致；Grigler-Najjar综合征是由于肝细胞缺乏葡萄糖醛酸转移酶，致不能形成结合胆红素，使血中非结合胆红素浓度增高；Rotor综合征是肝细胞摄取游离胆红素和排泄结合胆红素均有先天性缺陷，致血中结合胆红素增高为主。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"365","all_num":"492","types":0,"pname":"内科学"},{"id":"3964","name":"阿片类麻醉药的解毒药是：","data":{"A":"依地酸二钠钙","B":"亚甲蓝","C":"二巯基丁二酸","D":"氟马西尼","E":"纳洛酮"},"da_an":"E","typeid":"117","time":"2018-09-13 15:40:49","xiang_jie":"[考点]中毒的特殊解毒药治疗\r\n[考点还原]（P882）\u201c1）纳洛酮：是阿片类麻醉药的解毒药，对麻醉镇痛药引起的呼吸抑制有特异性拮抗作用\u201d（E对）。                                                                                                    \r\n[解析]这是关于中毒时特殊解毒药的应用问题，纳洛酮是阿片类麻醉药的解毒药，对麻醉镇痛药引起的呼吸抑制有特异的拮抗作用；亚硝酸盐中毒时引起高铁血红蛋白血症，亚甲蓝可使高铁血红蛋白还原为正常血红蛋白。而依地酸二钠钙和二巯基丁二酸是金属中毒的解毒剂；氟马西尼是苯二氮䓬类中毒的拮抗剂。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"431","all_num":"483","types":0,"pname":"内科学"},{"id":"3969","name":"亚硝酸盐中毒的解毒药是","data":{"A":"依地酸二钠钙","B":"亚甲蓝","C":"二巯基丁二酸","D":"氟马西尼","E":"纳洛酮"},"da_an":"B","typeid":"117","time":"2018-09-13 15:41:22","xiang_jie":"[考点]中毒的特殊解毒药治疗                                                                                                     [考点还原]（P881）\u201c（2）高铁血红蛋白血症解毒药：亚甲蓝（美蓝）（B对）：小剂量亚甲蓝可使高铁血红蛋白还原为正常血红蛋白，用于治疗亚硝酸盐、苯胺或硝基苯等中毒引起的高铁血红蛋白血症\u201d。\r\n[解析]这是关于中毒时特殊解毒药的应用问题，纳洛酮是阿片类麻醉药的解毒药，对麻醉镇痛药引起的呼吸抑制有特异的拮抗作用；亚硝酸盐中毒时引起高铁血红蛋白血症，亚甲蓝可使高铁血红蛋白还原为正常血红蛋白。而依地酸二钠钙和二巯基丁二酸是金属中毒的解毒剂；氟马西尼是苯二氮䓬类中毒的拮抗剂。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"411","all_num":"496","types":0,"pname":"内科学"},{"id":"3972","name":"血液灌流可清除的脂溶化合物是","data":{"A":"短效巴比妥类","B":"苯巴比妥","C":"水杨酸类","D":"甲醇","E":"锂"},"da_an":"A","typeid":"117","time":"2018-09-13 15:41:47","xiang_jie":"[考点]中毒的治疗\r\n[考点还原]（P880）\u201c2）血液灌流\u2026此法能吸附脂溶性或与蛋白质结合的化学物，能清除血液中巴比妥类（短效（A对）、长效（B对））和百草枯等，是目前最常用的中毒抢救措施\u201d。（P880）\u201c1）血液透析：用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥、水杨酸类（C错）、甲醇（D错）、茶碱、乙二醇和锂（E错）等）\u201d                             \r\n[解析]短效巴比妥类是脂溶性化学物质，所以透析效果不好，而血液灌流能吸附脂溶性或与蛋白质结合的化学物质，所以可以清除。其余各项都非脂溶性，所以两题的答案都是A。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"293","all_num":"520","types":0,"pname":"内科学"},{"id":"3975","name":"透析疗法不能很好清除的是","data":{"A":"短效巴比妥类","B":"苯巴比妥","C":"水杨酸类","D":"甲醇","E":"锂"},"da_an":"A","typeid":"117","time":"2018-09-13 15:42:24","xiang_jie":"[考点]中毒的治疗                                                                                                                        \r\n [考点还原]（P880）\u201c1）血液透析：用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥（B错）、水杨酸类（C错）、甲醇（D错）、茶碱、乙二醇和锂（E错）等）。短效巴比妥类（A对）、格鲁米特（导眠能）和OPI因具有脂溶性，一般不进行血液透析\u201d。\r\n[解析]短效巴比妥类是脂溶性化学物质，所以透析效果不好，而血液灌流能吸附脂溶性或与蛋白质结合的化学物质，所以可以清除。其余各项都非脂溶性，所以两题的答案都是A。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"340","all_num":"544","types":0,"pname":"内科学"},{"id":"3977","name":"有机磷（对硫磷）农药中毒的洗胃液是","data":{"A":"1:5000高锰酸钾","B":"2%碳酸氢钠","C":"0.3%H2O2","D":"0.3%氧化镁","E":"5%硫酸钠"},"da_an":"B","typeid":"117","time":"2018-09-13 15:43:09","xiang_jie":"[考点]中毒的洗胃治疗\r\n[考点还原]（P879-P880）\u201c表9-2-4  洗胃液配制和应用注意要点\u201d（B对ACDE错）。（P886）\u201c（一）迅速清除毒物\u2026口服中毒者，用清水、2％碳酸氢钠溶液（敌百虫中毒者忌用）（B对）或1：5000高锰酸钾溶液（对硫磷中毒者忌用）（A错）反复洗胃\u201d。             \r\n[解析]中毒洗胃时所用的洗胃液应依毒物的种类不同而异，一般有机磷农药中毒的洗胃液可用1:5000高锰酸钾或2%碳酸氢钠，但对硫磷中毒时若用前者，会使其氧化为毒性更强的对氧磷，因此只能用后者；镇静药中毒的洗胃液是1:5000高锰酸钾，可有氧化解毒作用。而0.3%H2O2常用于阿片类等中毒，0.3%氧化镁作为中和剂用于阿司匹林、草酸中毒，5%硫酸钠作为沉淀剂用于氯化钡和碳酸钡中毒。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"324","all_num":"516","types":0,"pname":"内科学"},{"id":"3979","name":"镇静药物中毒的洗胃液是","data":{"A":"1:5000高锰酸钾","B":"2%碳酸氢钠","C":"0.3%H2O2","D":"0.3%氧化镁","E":"5%硫酸钠"},"da_an":"A","typeid":"117","time":"2018-09-13 15:43:55","xiang_jie":"[考点]中毒的洗胃治疗                                                                                                                \r\n[考点还原]（P879）\u201c表9-2-4  洗胃液配制和应用注意要点\u201d（A对）。\r\n[解析]中毒洗胃时所用的洗胃液应依毒物的种类不同而异，一般有机磷农药中毒的洗胃液可用1:5000高锰酸钾或2%碳酸氢钠，但对硫磷中毒时若用前者，会使其氧化为毒性更强的对氧磷，因此只能用后者；镇静药中毒的洗胃液是1:5000高锰酸钾，可有氧化解毒作用。而0.3%H2O2常用于阿片类等中毒，0.3%氧化镁作为中和剂用于阿司匹林、草酸中毒，5%硫酸钠作为沉淀剂用于氯化钡和碳酸钡中毒。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"358","all_num":"473","types":0,"pname":"内科学"},{"id":"3982","name":"最易并发原发性肝癌的是","data":{"A":"病毒性肝炎后肝硬化","B":"酒精性肝硬化","C":"原发性胆汁性肝硬化","D":"淤血性肝硬化","E":"血吸虫病性肝纤维化"},"da_an":"A","typeid":"117","time":"2018-09-13 15:44:23","xiang_jie":"[考点]肝硬化的实验室检查和并发症\r\n[考点还原]（P429）\u201c在我国，肝癌患者中约90％有乙型肝炎病毒感染的背景\u201d（A对）。  \r\n[解析]原发性肝癌合并肝硬化者占50%〜90%,病理检查发现多为病毒性（乙型或丙型病毒性肝炎）肝硬化，而欧美国家肝癌常发生在酒精性肝硬化的基础上，一般认为其余三种肝硬化与原发性肝癌的发生无关；原发性胆汁性肝硬化的80%以上患者血清抗线粒体抗体阳性，而且滴度很高，其他类型肝硬化不会如此，借此化验还可与其他胆汁淤积性黄疸鉴别。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"485","all_num":"496","types":0,"pname":"内科学"},{"id":"3984","name":"血清抗线粒体抗体阳性率高且滴度高的是","data":{"A":"病毒性肝炎后肝硬化","B":"酒精性肝硬化","C":"原发性胆汁性肝硬化","D":"淤血性肝硬化","E":"血吸虫病性肝纤维化"},"da_an":"C","typeid":"117","time":"2018-09-13 15:45:00","xiang_jie":"[考点]肝硬化的实验室检查和并发症                                                                                         \r\n[考点还原]（P414）\u201c（三）免疫学检查  95％以上患者AMA（血清抗线粒体抗体）阳性，滴度＞1：40有诊断意义，AMA的特异性可达98％\u201d（C对）。\r\n[解析]原发性肝癌合并肝硬化者占50%〜90%,病理检查发现多为病毒性（乙型或丙型病毒性肝炎）肝硬化，而欧美国家肝癌常发生在酒精性肝硬化的基础上，一般认为其余三种肝硬化与原发性肝癌的发生无关；原发性胆汁性肝硬化的80%以上患者血清抗线粒体抗体阳性，而且滴度很高，其他类型肝硬化不会如此，借此化验还可与其他胆汁淤积性黄疸鉴别。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"395","all_num":"564","types":0,"pname":"内科学"},{"id":"3988","name":"血液透析治疗急性中毒的首选指征是","data":{"A":"生物毒类中毒","B":"乙二醇中毒","C":"氯酸盐中毒","D":"导眠能（格鲁米特）中毒","E":"短效巴比妥类中毒"},"da_an":"C","typeid":"117","time":"2018-09-13 15:45:38","xiang_jie":"[考点]中毒的血液净化治疗\r\n[考点还原]（P880）\u201c1）血液透析\u2026氯酸盐（C对）或重铬酸盐中毒能引起急性肾衰竭，首选血液透析\u201d。                                                                                                                             \r\n[解析]血液透析可适用于清除血液中分子量较小、非脂溶性的毒物，氯酸盐和重铬酸盐能损害肾引起急性肾衰竭，因此是血液透析的首选指征，而短效巴比妥类、导眠能（格鲁米特）和有机磷杀虫药因具有脂溶性，透析效果不好。血浆置换无论是对溶液或与蛋白结合的毒物，特别是生物毒如蛇毒、蕈中毒及砷化氢等溶血毒物中毒，疗效更佳。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"208","all_num":"505","types":0,"pname":"内科学"},{"id":"3993","name":"最适于血浆置换治疗的中毒是：","data":{"A":"生物毒类中毒","B":"乙二醇中毒","C":"氯酸盐中毒","D":"导眠能（格鲁米特）中毒","E":"短效巴比妥类中毒"},"da_an":"A","typeid":"117","time":"2018-09-13 15:46:07","xiang_jie":"[考点]中毒的血液净化治疗                                                                                                         [考点还原]（P881）\u201c3）血浆置换：本疗法用于清除游离或与蛋白质结合的毒物，特别适用于生物毒（如蛇毒、蕈中毒）（A对）及砷化氢等溶血毒物中毒。一般需在数小时内置换3～5L血浆\u201d。\r\n[解析]血液透析可适用于清除血液中分子量较小、非脂溶性的毒物，氯酸盐和重铬酸盐能损害肾引起急性肾衰竭，因此是血液透析的首选指征，而短效巴比妥类、导眠能（格鲁米特）和有机磷杀虫药因具有脂溶性，透析效果不好。血浆置换无论是对溶液或与蛋白结合的毒物，特别是生物毒如蛇毒、蕈中毒及砷化氢等溶血毒物中毒，疗效更佳。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"318","all_num":"474","types":0,"pname":"内科学"},{"id":"3997","name":"侵入性检查幽门螺杆菌的首选方法是","data":{"A":"胃组织学检查","B":"快速尿素酶试验","C":"幽门螺杆菌培养","D":"14C尿素呼气试验","E":"血清学检查"},"da_an":"B","typeid":"117","time":"2018-09-13 15:46:34","xiang_jie":"[考点]幽门螺杆菌的检查方法\r\n[考点还原]（七版内科学P533）\u201c快速尿素酶试验是侵入性检查的首选方法\u201d（C对）          \r\n [解析]幽门螺杆菌的检查方法有侵入性和非侵入性两类，其中侵入性方法包括快速尿素酶试验、胃组织学检查及细菌培养等，快速尿素酶试验是侵入性检查幽门螺杆菌的首选方法。当幽门螺杆菌根除治疗后复查疗效时，首选的检查方法是l3C尿素呼气试验，这是最常用的非侵入性检查幽门螺杆菌的方法，虽然血清学检查也是非侵入性检查幽门螺杆菌的方法，但由于该方法检查的是抗幽门螺杆菌的抗体，当幽门螺杆菌根除治疗后，幽门螺杆菌可能已被根除，但其抗体却不会随幽门螺杆菌根除而消失；另外当幽门螺杆菌根除治疗后复查疗效时，也不会选用侵入性检查幽门螺杆菌的方法。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"508","all_num":"521","types":0,"pname":"内科学"},{"id":"4001","name":"作为幽门螺杆菌根除治疗后复查的首选方法是","data":{"A":"胃组织学检查","B":"快速尿素酶试验","C":"幽门螺杆菌培养","D":"14C尿素呼气试验","E":"血清学检查"},"da_an":"D","typeid":"117","time":"2018-09-13 15:47:22","xiang_jie":"[考点]幽门螺杆菌的检查方法                                                                                                     \r\n[考点还原]（七版内科学P390）\u201c¹³C或¹\u2074C尿素呼气试验检测幽门螺杆菌敏感性及特异性高而无需胃镜检查，可作为根除治疗后复查的首选方法\u201d（D对）。\r\n[解析]幽门螺杆菌的检查方法分为侵入性和非侵入性两大类，侵入性需通过胃镜取胃黏膜活组织进行检查，主要包括快速尿素酶试验、胃组织学检查和幽门螺杆菌培养，其中快速尿素酶试验是首选方法，因为操作简便，费用低；非侵入性包括13C或14C尿素呼气试验、粪便幽门螺杆菌抗原检测及血清学检查（定性检测血清抗幽门螺杆菌IgG抗体），因为13C或14C尿素呼气试验检测幽门螺杆菌敏感性和特异性高而无需作胃镜，所以作为幽门螺杆菌根除治疗后复查的首选方法。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"514","all_num":"524","types":0,"pname":"内科学"},{"id":"4007","name":"溃疡性结肠炎的并发症可有：","data":{"A":"中毒性巨结肠","B":"癌变","C":"肠出血","D":"肠穿孔"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:48:06","xiang_jie":"[考点]溃疡性结肠炎的并发症\r\n[考点还原]（P387）\u201c【并发症】（一）中毒性巨结肠（A对）\u2026\u2026本并发症易引起急性肠穿孔\u2026\u2026（二）直肠结肠癌变（B对）\u2026\u2026（三）其他并发症结肠大出血（C对）发生率约3%；肠穿孔（D对）多于中毒巨结肠有关\u201d\r\n[解析]溃疡性结肠炎是一种原因不明的直肠和结肠非特异性炎性疾病，临床上多呈反复发作慢性过程。该病的并发症包括中毒性巨结肠、肠穿孔、大量出血、结直肠癌、肠梗阻、瘘管形成和肛门、直肠周围病变等。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"348","all_num":"637","types":0,"pname":"内科学"},{"id":"4009","name":"下列药物中毒时采用血液透析治疗有效的有","data":{"A":"苯巴比妥","B":"茶碱","C":"水杨酸类","D":"有机磷杀虫药"},"da_an":"A@B@C","typeid":"117","time":"2018-09-13 15:48:49","xiang_jie":"[考点]血液透析治疗有效的药物中毒\r\n[考点还原]（P880）\u201c1）血液透析：用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥（A对）、水杨酸类（C对）、甲醇、茶碱（B对）、乙二醇和锂等）。短效巴比妥类、格鲁米特（导眠能）和OPI（D错）因具有脂溶性，一般不进行血液透析\u201d。\r\n[解析]血液透析治疗用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥、茶碱、水杨酸类、甲醇、乙二醇和锂等）。因此答案是ABC。而有机磷杀虫药是脂溶性的，所以血液透析治疗是无效的。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"241","all_num":"549","types":0,"pname":"内科学"},{"id":"4014","name":"根除胃幽门螺杆菌治疗时常用的药物包括","data":{"A":"雷尼替丁","B":"奥美拉唑","C":"硫糖铝","D":"克拉霉素"},"da_an":"B@D","typeid":"117","time":"2018-08-06 12:00:54","xiang_jie":"[考点]胃幽门螺杆菌（Hp）的根除治疗\r\n[考点还原]（P366）\u201c这些抗生素在酸性环境下不能正常发挥其抗菌作用，需要联合PPI抑制胃酸后，才能使其发挥作用。常用的联合方案有：1种PPI+2种抗生素或1种铋剂+2种抗生素，疗程7～14天\u201d（B对）。（P366）\u201c表4-4-1  具有杀灭和抑制Hp作用的药物\u201d（D对）。\r\n[解析]具有杀灭或抑制Hp作用的药物包括：①抗生素：克拉霉素、羟氨苄青霉素、甲硝唑、替硝唑、喹诺酮类抗生素、痢特灵、四环素；②质子泵抑制剂（PPI）：埃索美拉唑、兰索拉唑、奥美拉唑、潘托拉唑、雷贝拉唑等；③铋剂：三钾二枸橼酸铋、果胶铋、次碳酸铋。雷尼替丁和硫糖铝不属于根除胃幽门螺杆菌治疗时常用的药物。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"250","all_num":"627","types":0,"pname":"内科学"},{"id":"4016","name":"对原发性肝癌高危人群进行普查的主要方法有","data":{"A":"血清AFP测定","B":"腹部B超检查","C":"腹部CT检查","D":"肝MRI检查"},"da_an":"A@B","typeid":"117","time":"2018-09-13 15:49:56","xiang_jie":"[考点]原发性肝癌高危人群的普查\r\n[考点还原]（P431）\u201c1.甲胎蛋白（AFP） 是诊断肝细胞癌特异性的标志物，阳性率约为70％。现已广泛用于肝癌的普查、诊断、判断治疗效果及预测复发\u201d（A对）。（P431）\u201c1.超声（US） 是目前肝癌筛查的首选方法\u201d（B对）。\r\n[解析]原发性肝癌是我国常见的恶性肿瘤之一，其死亡率在恶性肿瘤中居第二位，因此对高危人群进行普查是必要的。血清AFP（甲胎蛋白）是诊断原发性肝癌特异性的标志物，阳性率约为70%，因此血清AFP测定现已广泛用于肝癌的普查；腹部B超检查具有方便易行、价格低廉及无创等优点，也是目前肝癌的筛查首选的方法；而腹部CT检查和肝MRI检查的价格均比较高，所以均不适于对原发性肝癌高危人群的普查，只有当血清AFP测定和腹部B超检查高度可疑肝癌时才适用。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"292","all_num":"580","types":0,"pname":"内科学"},{"id":"4020","name":"原发性肝癌发生的伴癌综合征的主要表现有","data":{"A":"自发性低血糖症","B":"高钙血症","C":"高脂血症","D":"红细胞增多症"},"da_an":"A@D","typeid":"117","time":"2018-09-13 15:50:24","xiang_jie":"[考点]原发性肝癌发生的伴癌综合征\r\n[考点还原]（P430）\u201c（六）伴癌综合征\u2026主要表现为自发性低血糖症（A对）、红细胞增多症（D对）；其他罕见的有高钙血症（B错）、高脂血症（C错）、类癌综合征等\u201d。\r\n[解析]伴癌综合征系指原发性肝癌患者由于癌肿本身代谢异常或癌组织对机体影响而引起内分泌或代谢异常的一组症候群，主要表现为自发性低血糖症、红细胞增多症，其他罕见的有高钙血症、高脂血症和类癌综合征等。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"285","all_num":"594","types":0,"pname":"内科学"},{"id":"4035","name":"下列属于慢性胃炎发病原因的有","data":{"A":"Hp感染","B":"自身免疫","C":"精神刺激","D":"十二指肠液反流入胃\t"},"da_an":"A@B@D","typeid":"117","time":"2018-09-13 15:51:06","xiang_jie":"[考点]慢性胃炎的发病原因\r\n[考点还原]（P364）\u201c【病因和发病机制】 （一）Hp感染（A对）\u2026（二）十二指肠-胃反流（D对）\u2026（三）自身免疫（B对）\u2026（四）年龄因素和胃黏膜营养因子缺乏\u201d。\r\n[解析]慢性胃炎是由各种病因引起的胃黏膜慢性炎症，发病原因包括Hp感染、自身免疫、饮食和环境因素及其他因素（如含胆汁和胰液的十二指肠液反流入胃、服用NSAID等药物、某些刺激性食物等）。而精神刺激一般不是慢性胃炎的发病原因。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"219","all_num":"601","types":0,"pname":"内科学"},{"id":"4040","name":"在治疗溃疡性结肠炎的常用药物中，可避免在小肠近段被吸收的氨基水杨酸制剂有","data":{"A":"柳氮磺吡啶","B":"巴柳氮","C":"美沙拉嗪","D":"奥沙拉嗪"},"da_an":"B@C@D","typeid":"117","time":"2018-09-13 15:51:39","xiang_jie":"[考点]溃疡性结肠炎的常用治疗药物\r\n[考点还原]（七版内科学P414）\u201c口服5-ASA新型制剂可避免在小肠近段被吸收，而在结肠内发挥药效，这类制剂有各种控释剂型的美沙拉嗪、奥沙拉嗪、巴柳氮\u201d（BCD对）。\r\n[解析]本题是一道记忆型题，可避免在小肠近段被吸收的氨基水杨酸制剂有巴柳氮、美沙拉嗪、奥沙拉嗪，这是治疗溃疡性结肠炎的新型制剂，优点是不良反应明显减少，但价格昂贵。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"266","all_num":"568","types":0,"pname":"内科学"},{"id":"4045","name":"下列关于急性中毒特殊解毒药的应用，正确的是","data":{"A":"依地酸钙钠治疗铅中毒","B":"二巯丙醇治疗砷中毒","C":"去铁胺治疗镁中毒","D":"亚甲蓝治疗亚硝酸盐中毒\t"},"da_an":"A@B@D","typeid":"117","time":"2018-08-06 12:08:36","xiang_jie":"[考点]急性中毒特殊解毒药的应用\r\n[考点还原]（P881）\u201c表9-2-5  毒物络合剂的应用\u201d（AB对C错）。（P881）\u201c（2）高铁血红蛋白血症解毒药：亚甲蓝（美蓝）：小剂量亚甲蓝可使高铁血红蛋白还原为正常血红蛋白，用于治疗亚硝酸盐、苯胺或硝基苯等中毒引起的高铁血红蛋白血症\u201d（D对）。\r\n[解析]某些急性中毒常有相应的特殊解毒药，临床上应用后会取得非常显著的疗效，如依地酸钙钠治疗铅中毒、二巯丙醇治疗砷中毒、亚甲蓝治疗亚硝酸盐中毒和去铁胺治疗铁中毒等，而去铁胺不是治疗镁中毒。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"241","all_num":"480","types":0,"pname":"内科学"},{"id":"4049","name":"胃食管反流病患者中，由反流物引起的临床表现有","data":{"A":"癔球症","B":"咽喉炎、声嘶","C":"非季节性哮喘","D":"反复发生肺炎"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:52:17","xiang_jie":"[考点]胃食管反流病的临床表现\r\n[考点还原]（P357-P358）\u201c（二）食管外症状  由反流物刺激或损伤食管以外的组织或器官引起，如咽喉炎、慢性咳嗽和哮喘（BC对）\u2026严重者可发生吸入性肺炎（D对）\u2026一些患者诉咽部不适，有异物感或堵塞感，但无吞咽困难，称为癔球症（A对），目前也认为与GERD相关\u201d。\r\n[解析]胃食管反流病患者中，由反流物直接引起食管症状很常见，但反流物刺激或损伤食管外的组织或器官也常引起一些临床表现，易被忽视，本题中的四种临床表现均为反流物刺激或损伤食管外的组织或器官引起的临床表现。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"281","all_num":"564","types":0,"pname":"内科学"},{"id":"4053","name":"下列肝硬化的临床类型中，发现肝肿大的有","data":{"A":"肝炎后肝硬化","B":"淤血性肝硬化","C":"酒精性肝硬化","D":"原发性胆汁性肝硬化\t"},"da_an":"B@C@D","typeid":"117","time":"2018-09-13 15:52:50","xiang_jie":"[考点]肝硬化的临床表现\r\n[考点还原]  八版内科学未明确说明。\r\n[解析]这是一道记忆题，一般肝硬化的肝脏是缩小的，如肝炎后肝硬化等，而淤血性肝硬化、酒精性肝硬化和原发性胆汁性肝硬化患者的肝脏是肿大的。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"287","all_num":"511","types":0,"pname":"内科学"},{"id":"4058","name":"治疗急性有机磷中毒时，出现\u201c阿托品化\u201d的表现有","data":{"A":"瞳孔扩大","B":"颜面潮红","C":"心率减慢","D":"肺部啰音消失"},"da_an":"A@B@D","typeid":"117","time":"2018-08-06 12:10:59","xiang_jie":"[考点]有机磷中毒治疗时的阿托品应用\r\n[考点还原]（P888）\u201c（1）M胆碱受体拮抗药\u2026阿托品化指征为口干、皮肤干燥、心率增快（90～100次/分）（C错）和肺湿啰音消失（D对）\u201d。\r\n[解析]当治疗有机磷中毒时，常应用阿托品以对抗体内过多的乙酰胆碱，当出现\u201c阿托品化\u201d时，说明已达到治疗剂量，\u201c阿托品化\u201d时的表现为瞳孔扩大、颜面潮红、心率增快、肺部啰音消失等，因此答案应选ABD。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"232","all_num":"491","types":0,"pname":"内科学"},{"id":"4060","name":"背部疼痛可发生于","data":{"A":"胰腺癌","B":"球后溃疡","C":"幽门梗阻","D":"穿透性溃疡"},"da_an":"A@B@D","typeid":"117","time":"2018-09-13 15:53:33","xiang_jie":"[考点]消化系统疾病临床表现\r\n[考点还原]（P370）\u201c3.球后溃疡\u2026疼痛可向右上腹及背部放射\u201d（B对）。（P371）\u201c2.溃破穿孔并受阻于毗邻实质性器官，如肝、胰、脾等（穿透性溃疡） 发生较慢，改变了腹痛规律，变得顽固而持续。如穿透至胰腺，腹痛放射至背部，血淀粉酶可升高\u201d（D对）。（P371）\u201c临床症状常有：明显上腹胀痛，餐后加重，呕吐后腹痛可稍缓解，呕吐物可为宿食\u201d（C错）。（P449）\u201c典型腹痛为：持续、进行性加剧的中上腹痛或持续腰背部剧痛，可有阵发性绞痛\u201d（A对）。\r\n[解析]凡病变侵犯到腹腔神经丛者均可引起背部疼痛，胰腺癌在后腹腔，可浸润或压迫腹腔神经丛，因而可引起背痛；球后溃疡一般发生在十二指肠降部的十二指肠乳头近端，常发生于后壁，可影响腹腔神经丛引起背痛；穿透性溃疡发生于后壁时亦同样引起背痛。而幽门梗阻则不会引起背痛。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"263","all_num":"536","types":0,"pname":"内科学"},{"id":"4063","name":"关于萎缩性胃窦胃炎，下列哪几项正确","data":{"A":"可同时伴有胃体黏膜灶性萎缩","B":"可伴有浅表性胃炎","C":"可能与幽门螺杆菌相关","D":"可能与胆汁反流有关\t"},"da_an":"A@B@C@D","typeid":"117","time":"2018-08-06 12:12:37","xiang_jie":"[考点]萎缩性胃窦胃炎\r\n[考点还原]（P364）\u201c（一）Hp感染\u2026（二）十二指肠-胃反流（D对）\u2026（三）自身免疫\u201d。（八版病理学P188-P189）\u201c2.慢性萎缩性胃炎\u2026部分由慢性浅表性胃炎迁延发展而来\u201d（B对）。\r\n[解析]萎缩性胃窦胃炎以胃窦部为主，可同时伴有胃体黏膜灶性萎缩，也可伴有浅表性胃炎。关于萎缩性胃窦胃炎的发病机制尚未完全明了，发现胃窦黏膜层接近上皮细胞表面有大量幽门螺杆菌，因此考虑可能与感染幽门螺杆菌相关，另外发现患者常有幽门括约肌功能失调，引起胆汁反流，因此考虑也可能与胆汁反流有关。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"231","all_num":"548","types":0,"pname":"内科学"},{"id":"4065","name":"胃内幽门螺杆菌阳性常见于","data":{"A":"糜烂性胃炎","B":"活动性胃炎","C":"十二指肠球溃疡","D":"十二指肠球炎"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:54:48","xiang_jie":"[考点]与幽门螺杆菌有关疾病\r\n[考点还原]（P364）\u201c幽门螺杆菌感染是最常见的病因\u201d（B对）。（P369）\u201c十二指肠球部溃疡患者的Hp感染率高达90％～100％\u201d（C对）。\r\n[解析]糜烂性胃炎、活动性胃炎、十二\r\n指肠球溃疡和十二指肠球炎均可在黏膜中检得幽门螺杆菌。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"221","all_num":"527","types":0,"pname":"内科学"},{"id":"4067","name":"胃酸缺乏常见于","data":{"A":"胃癌","B":"胃溃疡","C":"慢性胃体胃炎","D":"慢性胃窦胃炎"},"da_an":"A@C","typeid":"117","time":"2018-09-13 15:55:34","xiang_jie":"[考点]胃酸检查\r\n[考点还原]（八版病理学P189）\u201c表9-1  慢性萎缩性胃炎A、B型比较表\u201d（C对D错）。\r\n[解析]胃癌时胃酸缺乏，这常是癌性溃疡区别于良性溃疡的特点之一；慢性胃体胃炎时，因为泌胃酸的壁细胞受影响，故胃酸亦缺乏。而胃溃疡和慢性胃窦胃炎时胃酸常正常或稍减少。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"226","all_num":"543","types":0,"pname":"内科学"},{"id":"4069","name":"对发热、腹痛、血性腹水的患者应考虑：","data":{"A":"结核性腹膜炎","B":"门静脉血栓形成","C":"胰源性腹水","D":"门脉性肝硬化"},"da_an":"A@B@C","typeid":"117","time":"2018-09-13 15:56:04","xiang_jie":"[考点]结核性腹膜炎等的鉴别诊断\r\n[考点还原]（P382）\u201c（一）全身症状  结核毒血症常见，主要是低热与中等热\u201d。（P382）\u201c（二）腹痛  位于脐周、下腹或全腹，持续或阵发性隐痛\u201d。（P383）\u201c（二）腹水检验  腹水多为草黄色渗出液，静置后可自然凝固，少数为浑浊或淡血性，偶见乳糜性\u201d（A对）。（P424）\u201c（四）门静脉血栓形成或海绵样变  急性或亚急性发展时，表现为中、重度腹胀痛或突发剧烈腹痛、脾大、顽固性腹水、肠坏死、消化道出血及肝性脑病等，腹穿可抽出血性腹水\u201d（B对）。（P425）\u201c血性腹水应考虑合并肝癌、门静脉血栓形成及结核性腹膜炎\u201d（AB对D错）。（七版外科学P578）\u201c胰液中的各种酶被激活后发挥作用的共同结果是胰腺和胰周组织广泛充血、水肿甚至出血、坏死。并在腹腔和腹膜后渗出大量的液体\u201d（C对）。\r\n[解析]结核性腹膜炎为结核菌感染腹腔所致，故可有发热、腹痛、血性腹水；门静脉血栓形成可突然出现腹痛、血性腹水，有时也可伴低热；胰源性腹水为胰腺炎特别是出血坏死型胰腺炎及胰腺癌腹膜浸润所致，因此也有发热、腹痛和血性腹水。而单纯性门脉性肝硬化为漏出液，不发热，腹水亦非血性。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"193","all_num":"544","types":0,"pname":"内科学"},{"id":"4071","name":"关于肝硬化的治疗有","data":{"A":"代偿期用高热量、高蛋白及丰富维生素饮食","B":"同时选用多种保肝药物治疗","C":"肝硬化合并症治疗","D":"伴有慢性活动性肝炎者，可试用肾上腺皮质激素治疗"},"da_an":"A@C@D","typeid":"117","time":"2018-09-13 15:56:38","xiang_jie":"[考点]肝硬化的治疗\r\n[考点还原]（七版内科学P453）\u201c（一）一般治疗\u20262.饮食  以高热量、高蛋白（肝性脑病时饮食限制蛋白质，见第十六章）和维生素，丰富而易消化的食物为原则\u201d（A对）。（P426）\u201c4.保护肝细胞  保护肝细胞药物虽有一定药理学基础，但普遍缺乏循证医学证据，过多使用可加重肝脏负担\u201d（B错）。（P426）\u201c（二）门静脉高压症状及其并发症治疗\u201d（C对）。\r\n[解析]关于肝硬化的治疗，在代偿期以高热量、高蛋白质及丰富维生素饮食为宜，同时应对合并症如上消化道出血、感染、肝性昏迷等进行治疗，当病理组织和免疫学证实有慢性活动性肝炎时，试用肾上腺皮质激素治疗可能有效。所谓保肝药物治疗并无肯定疗效，多用反而可增加肝脏负担，因此同时选用多种保肝药物治疗是不正确的。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"208","all_num":"493","types":0,"pname":"内科学"},{"id":"4072","name":"结核性腹膜炎腹水性质可为：","data":{"A":"草黄色渗出液","B":"淡血色","C":"合并肝硬化的患者可接近漏出液","D":"乳糜性"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:57:08","xiang_jie":"[考点]结核性腹膜炎的腹水特点\r\n[考点还原]（P383）\u201c腹水多为草黄色渗出液（A对），静置后可自然凝固，少数为浑浊或淡血性（B对），偶见乳糜性（D对），比重一般超过1.018，蛋白质定性试验阳性，定量在30g/L以上，白细胞计数超过500×10\u2076/L，以淋巴细胞或单核细胞为主\u201d。\r\n[解析]结核性腹膜炎的腹水为草黄色渗出液，少数为淡血色，偶见乳糜性，当合并肝硬化时可接近漏出液，因此四个答案均正确。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"247","all_num":"501","types":0,"pname":"内科学"},{"id":"4077","name":"下列哪几项是肠结核必须手术治疗的指征","data":{"A":"肠梗阻","B":"急性肠穿孔","C":"慢性肠穿孔引起粪瘘经内科治疗不见好转","D":"肠道大量出血经积极抢救不能满意止血"},"da_an":"B@C@D","typeid":"117","time":"2018-09-13 15:57:41","xiang_jie":"[考点]肠结核手术治疗的适应证\r\n[考点还原]（P381）\u201c（三）手术治疗  适应证：①完全性肠梗阻或部分性肠梗阻内科治疗无效者（A错）；②急性肠穿孔（B对），或慢性肠穿孔瘘管形成经内科治疗而未能闭合者（C对）；③肠道大量出血经积极抢救不能有效止血者（D对）；④诊断困难需开腹探查者\u201d。\r\n[解析]肠结核发生急性肠穿孔或慢性肠穿孔引起粪瘘经内科治疗不见好转和肠道大量出血经积极抢救不能满意止血者必须手术治疗，而肠梗阻中只有完全性肠梗阻才必须手术，不完全肠梗阻还可非手术治疗。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"237","all_num":"478","types":0,"pname":"内科学"},{"id":"4080","name":"下列哪些物质中毒可采用腹膜透析","data":{"A":"苯巴比妥","B":"甲醇","C":"导眠能","D":"有机磷杀虫药"},"da_an":"A@B","typeid":"117","time":"2018-09-13 15:58:09","xiang_jie":"[考点]中毒时腹膜透析治疗的适应证\r\n[考点还原]（P880）\u201c1）血液透析：用于清除血液中分子量较小和非脂溶性的毒物（如苯巴比妥（A对）、水杨酸类、甲醇（B对）、茶碱、乙二醇和锂等）。短效巴比妥类、格鲁米特（导眠能）（C错）和OPI（D错）因具有脂溶性，一般不进行血液透析\u201d。\r\n[解析]可用腹膜透析清除血液中的苯巴比妥和甲醇，但因导眠能（格鲁米特）和有机磷杀虫药是脂溶性物质，透析效果不好，所以不可采用腹膜透析。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"194","all_num":"459","types":0,"pname":"内科学"},{"id":"4092","name":"下列哪些是炎症性肠病的肠外表现","data":{"A":"杵状指","B":"虹膜睫状体炎","C":"口腔黏膜溃疡","D":"结节性红斑"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:58:41","xiang_jie":"[考点]炎症性肠病的肠外表现\r\n[考点还原]（P386）\u201c（三）肠外表现  包括外周关节炎、结节性红斑（D对）、坏疽性脓皮病、巩膜外层炎、前葡萄膜炎、口腔复发性溃疡（C对）等，这些肠外表现在结肠炎控制或结肠切除后可以可以缓解或恢复\u201d。\r\n[解析]炎症性肠病包括Crohn病和溃疡性结肠炎，均可有一些肠外表现，杵状指、虹膜睫状体炎、口腔黏膜溃疡和结节性红斑均可见到。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"201","all_num":"496","types":0,"pname":"内科学"},{"id":"4097","name":"下列哪些药物被认为可能诱发急性胰腺炎","data":{"A":"硫唑嘌呤","B":"四环素","C":"磺胺","D":"肾上腺糖皮质激素\t"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:59:12","xiang_jie":"[考点]急性胰腺炎的病因\r\n[考点还原]（P439）\u201c噻嗪类利尿剂、硫唑嘌呤（A对）、糖皮质激素（D对）、磺胺类（C对）等药物可促发急性胰腺炎\u201d。（七版内科学P470）\u201c已知应用某些药物如噻嗪类利尿剂、硫唑嘌呤（A对）、糖皮质激素（D对）、四环素（B对）、磺胺类（C对）等可直接损伤胰腺组织，可使胰液分泌或黏稠度增加，引起急性胰腺炎\u201d。\r\n[解析]这是道记忆题，已确认题中所列出的四种药物均可诱发急性胰腺炎，这些药物可使胰液分泌或其黏稠度增加。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"224","all_num":"473","types":0,"pname":"内科学"},{"id":"4103","name":"通过影响LES压，能促进胃食管反流病发生的是","data":{"A":"胆囊收缩素","B":"胰升糖素","C":"血管活性肠肽","D":"地西泮"},"da_an":"A@B@C@D","typeid":"117","time":"2018-08-06 12:21:26","xiang_jie":"[考点]胃食管反流病的病因和发病机制\r\n[考点还原]（P357）\u201c贲门失弛缓症手术后\u2026某些激素（如缩胆囊素、胰高血糖素、血管活性肠肽等）（ABC对）、食物（如高脂肪、巧克力等）、药物（如钙通道阻滞剂、地西泮（D对）等可引起LES功能障碍或一过性LES松弛延长\u201d。\r\n[解析]LES是食管下括约肌，是指食管末端约3〜4cm长的环形肌束，正常人休息时为一高压带，防止胃内容物反流入食管。一些因素可影响LESS,使之下降，促进胃食管反流病的发生。题中所列出的四种因素均可影响LES压，促进胃食管反流病的发生。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"230","all_num":"476","types":0,"pname":"内科学"},{"id":"4106","name":"可能逆转慢性胃炎病人胃黏膜之肠化和不典型增生的药物是","data":{"A":"β胡萝卜素","B":"维生素C","C":"维生素E","D":"叶酸"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 15:59:58","xiang_jie":"[考点]慢性胃炎的治疗\r\n[考点还原]（P366）\u201c（三）癌前状态处理  近年大样本的临床研究提示，口服选择性COX-2抑制剂塞来昔布对胃黏膜重度炎症、肠化、萎缩及异型增生的逆转有一定益处；也可适量补充复合维生素（ABCD对）和含硒食物等\u201d。\r\n[解析]慢性胃炎病人可有胃黏膜之肠化和不典型增生，题中所列出的四种药物为抗氧化维生素，均有可能帮助其逆转。但对较重的病变应定期做胃镜检查随访，对重度不典型增生宜手术治疗。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"216","all_num":"471","types":0,"pname":"内科学"},{"id":"4112","name":"治疗肠易激综合征可选用的药物有：","data":{"A":"胃肠解痉药","B":"止泻药","C":"泻药","D":"抗抑郁药"},"da_an":"A@B@C@D","typeid":"117","time":"2018-09-13 16:00:53","xiang_jie":"[考点]肠易激综合征（IBS）的治疗\r\n[考点还原]（P400）\u201c（二）药物对症治疗  1.解痉药（A对） 抗胆碱药可作为缓解腹痛的短期对症治疗\u20262.止泻药（B对） 洛哌丁胺或地芬诺酯止泻效果好，适用于腹泻症状较重者，但不宜长期使用。轻症者宜使用吸附止泻药如蒙脱石、药用炭等。3.泻药（C对）  对便秘型患者酌情使用泻药\u20264.抗抑郁药（D对） 对腹痛症状重，上述治疗无效且精神症状明显者可试用。临床研究表明这类药物甚至对不伴有明显精神症状者亦有一定疗效\u201d。\r\n[解析]IBS病人有腹痛，这是由于胃肠道平滑肌痉挛所致，所以可以用胃肠解痉药治疗腹痛；IBS病人还有腹泻或便秘，因此可以用止泻药或泻药治疗；IBS的发病还与精神因素有关，心理应激对胃肠道运动有明显影响，因此用抗抑郁药可能对改善症状有辅助作用。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"252","all_num":"463","types":0,"pname":"内科学"},{"id":"4122","name":"胃食管反流病的治疗目的是","data":{"A":"控制症状","B":"减少复发","C":"防止食管狭窄","D":"避免食管穿孔"},"da_an":"A@B@C","typeid":"117","time":"2018-09-13 16:02:14","xiang_jie":"[考点还原]（P358）\u201c（三）并发症  1.上消化道出血\u20262.食管狭窄\u20263.Barrett食管\u201d（C对）。（P358）\u201c目的在于控制症状、治愈食管炎、减少复发和防治并发症\u201d（AB对）。\r\n[考点]胃食管反流病的治疗目的[解析]胃食管反流病是指胃十二指肠内容物反流入食管引起烧心等症状及咽喉、气道等食管外的组织损害，治疗的目的是控制症状、减少复发和防止并发症（包括上消化道出血、食管狹窄、Barrett食管），达到治愈的目标。因此答案是ABC","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"235","all_num":"515","types":0,"pname":"内科学"},{"id":"10008","name":"关于肾上腺皮质激素治疗克罗恩病，下列哪项不正确：","data":{"A":"用于本病活动期，对控制症状有效","B":"长期应用可防止复发","C":"一般开始口服泼尼松每日40〜60mg","D":"严重者可静脉给药","E":"有瘘管形成者应慎用"},"da_an":"B","typeid":"117","time":"2018-10-30 17:34:33","xiang_jie":"[答案]B\r\n[考点]克罗恩病的治疗\r\n[考点还原]（P389）\u201c2.糖皮质激素\u2026一般予口服泼尼松0.75～1mg/kg，口服最大剂量一般为60mg/d（C对）；重症患者先予大剂量静脉滴注（D对）\u201d。（P392）\u201c（2）糖皮质激素：对控制病情活动有较好疗效\u201d（A对）。\r\n[解析]肾上腺皮质激素治疗克罗恩病不能防止复发，因此B是不正确的，其余各项均正确。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"362","all_num":"513","types":0,"pname":"内科学"},{"id":"10009","name":"肝性脑病时中枢神经系统的多巴胺合成减少，故应给予：","data":{"A":"多巴胺","B":"复方氨基酸溶液","C":"乙酰谷氨酰胺","D":"左旋多巴","E":"乳果糖"},"da_an":"D","typeid":"117","time":"2018-10-30 17:35:20","xiang_jie":"[考点]肝性脑病的治疗\r\n[考点还原]（七版药学类专业用药理学P297）\u201c（2）治疗肝性脑病：进入脑中的左旋多巴（D对）可以合成去甲肾上腺素，利于中枢神经系统功能的恢复，这样可以使肝性脑病的患者清醒，但是不能改善肝脏的功能\u201d。\r\n[解析]左旋多巴是多巴胺的前体，可透过血脑屏障进入脑组织，起到多巴胺的作用，而多巴胺不能透过血脑屏障，其他三种均与多巴胺无关。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"418","all_num":"476","types":0,"pname":"内科学"},{"id":"10010","name":"关于肝肾综合征，下列哪项不正确","data":{"A":"多发生于有大量腹水的失代偿期肝硬化","B":"表现为少尿或无尿","C":"肾衰竭为不可逆性","D":"低钠血症","E":"低尿钠症"},"da_an":"C","typeid":"117","time":"2018-10-30 17:37:10","xiang_jie":"[答案]C\r\n[考点]肝肾综合征的临床特点\r\n[考点还原]（七版内科学P450）\u201c（六）肝肾综合征\u2026主要见于伴有腹水的晚期肝硬化（A对）或急性肝功能衰竭的患者\u2026HRS临床表现为自发性少尿或无尿（B对），氮质血症和血肌酐升高，稀释性低钠血症（D对），低尿钠（E对）\u201d。（十四版实用内科学P2001）\u201c5.泌尿系统  肝肾综合征时，患者虽然有肾功能不全，但是肾脏可无组织学上改变，是可逆的循环相关性肾衰竭\u201d（C错，为本题正确答案）。\r\n[解析]肝肾综合征时，肾无重要病理改变，而是由于肾血管收缩引起的功能性肾衰竭，因而应该是可逆性的，而不是不可逆性的，其余各项均正确。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"420","all_num":"463","types":0,"pname":"内科学"},{"id":"10011","name":"男性，25岁，节律性间断上腹隐痛3年，加重2天，10小时前开始黑便3次，量约1000g,BP 9/6kPa（67.5/45mmHg）,P 120次/分，Hb 90g/L，首选下列哪种治疗：","data":{"A":"大量输液","B":"输右旋糖酐","C":"外科手术","D":"急诊内镜止血","E":"输血、补液"},"da_an":"E","typeid":"117","time":"2018-10-30 17:37:52","xiang_jie":"[答案]E\r\n[考点]溃疡病大出血的紧急治疗\r\n[考点还原]（P452）\u201c（一）呕血与黑粪  是上消化道出血的特征性表现，上消化道大量出血后，均有黑粪。出血部位在幽门以上者常伴有呕血\u2026黑粪呈柏油样，黏稠而发亮\u201d（P454）\u201c消化道大量出血病情急、变化快，抗休克、迅速补充血容量治疗应放在一切医疗措施的首位\u201d（E对）。\r\n[解析]根据简单病史，考虑此病人为溃疡病大量出血后伴低血压状态和急性失血性贫血，因而首选治疗应该是输血、补液，以迅速纠正低血压状态和贫血，其他治疗方法均不宜首选。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"350","all_num":"465","types":0,"pname":"内科学"},{"id":"10012","name":"关于球后溃疡的临床表现，下列哪项不符合：","data":{"A":"夜间痛常见","B":"痛常向背部放散","C":"症状较一般十二指肠溃疡严重而持续","D":"不易出血","E":"内科疗效差"},"da_an":"D","typeid":"117","time":"2018-10-30 17:38:33","xiang_jie":"[答案]D\r\n[考点]球后溃疡的临床表现特点\r\n[考点还原]（七版内科学P390）\u201c球后溃疡具有DU的临床特点，但午夜痛及背部放射痛多见（AB对），对药物治疗反应较差（E对），较易并发出血（D错，为本题正确答案）\u201d。\r\n[解析]球后溃疡易出血，发生率约60%，因而D不符合球后溃疡的临床表现，其余各项均符合。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"418","all_num":"455","types":0,"pname":"内科学"},{"id":"10013","name":"溃疡性结肠炎病变多位于：","data":{"A":"回肠末端及升结肠","B":"升结肠","C":"降结肠","D":"全结肠","E":"直肠及乙状结肠"},"da_an":"E","typeid":"117","time":"2018-10-30 17:39:06","xiang_jie":"[答案]E\r\n[考点]溃疡性结肠炎的好发部位\r\n[考点还原]（P385）\u201c病变多自直肠开始，逆行向近段发展，可累及全结肠甚至末端回肠\u201d（E对）。\r\n[解析]这是道记忆题，溃疡性结肠炎病变多位于直肠及乙状结肠，故答案是E。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"428","all_num":"470","types":0,"pname":"内科学"},{"id":"10014","name":"关于消化性溃疡的叙述，下列哪一项不正确：","data":{"A":"在临床上，十二指肠溃疡较胃溃疡多见","B":"绝大多数病例病变位于胃和十二指肠","C":"男性发病多于女性","D":"全世界均多见","E":"童年及老年均罕见"},"da_an":"E","typeid":"117","time":"2018-10-30 17:39:46","xiang_jie":"[考点]消化性溃疡的流行病学\r\n[考点还原]（P369）\u201c消化性溃疡是一种全球性常见病（D对），估计约有10％左右的人在其一生中患过本病。本病可发生于任何年龄段。十二指肠溃疡多（DU）多见于青壮年，而胃溃疡（GU）则多见于中老年（E错，为本题正确答案）；前者的发病高峰一般比后者早10年。临床上十二指肠球部溃疡多于胃溃疡（A对），十二指肠球部溃疡与胃溃疡发生率的比值大约为3：1。不论是胃溃疡还是十二指肠球部溃疡均好发于男性（C对）\u201d。\r\n[解析]消化性溃疡是人类的常见病，童年和老年亦非罕见，因而E是不正确的，其余各项均正确。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"396","all_num":"479","types":0,"pname":"内科学"},{"id":"10015","name":"血清碱性磷酸酶明显增高，可见于哪种黄疸","data":{"A":"肝细胞性黄疸","B":"溶血性黄疸","C":"Roter综合征引起的黄疸","D":"Gilbert综合征引起的黄疸","E":"阻塞性黄疸"},"da_an":"E","typeid":"117","time":"2018-10-30 17:40:20","xiang_jie":"[答案]E\r\n[考点]黄疸的鉴别诊断\r\n[考点还原]  八版生物化学未明确说明。\r\n[解析]血清碱性磷酸酶（ALP）大部分来源于肝脏和骨骼，主要经胆道排泄，当胆道疾病引起阻塞性黄疸时，由于ALP排泄减少而明显升高，因而血清ALP明显增高是阻塞性黄疸的特点，也是与其他各种黄疸的鉴别要点之一，所以答案应该是E，而其余各种黄疸均无血清碱性磷酸酶增高。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"226","all_num":"458","types":0,"pname":"内科学"},{"id":"10016","name":"服毒后的洗胃处理，下列哪项不正确：","data":{"A":"一般在服毒后6小时内洗胃有效","B":"超过6小时多数洗胃已无必要","C":"吞服强腐蚀性毒物者，不宜洗胃","D":"惊厥患者不宜插管洗胃","E":"昏迷患者插胃管易致吸入性肺炎，洗胃应慎重"},"da_an":"B","typeid":"117","time":"2018-10-30 17:40:55","xiang_jie":"[答案]B\r\n[考点]中毒的洗胃\r\n[考点还原]（P879）\u201c（3）洗胃  1）适应证：用于口服毒物1小时以内者；对于服用吸收缓慢的毒物、胃蠕动功能减弱或消失者，服毒4～6小时后仍应洗胃（B错，为本题正确答案）。2）禁忌证：吞服强腐蚀性毒物（C对）、食管静脉曲张、惊厥（D对）或昏迷（E对）患者，不宜进行洗胃\u201d。\r\n[解析]服毒后一般在6小时内洗胃肯定有效，但即使已超过6小时，由于部分毒物仍可滞留于胃内，多数仍有洗胃的必要，因而超过6小时多数洗胃已无必要是不正确的，其余关于洗胃的处理均是正确的。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"388","all_num":"420","types":0,"pname":"内科学"},{"id":"10017","name":"溃疡性结肠炎最多见的临床类型是","data":{"A":"初发型","B":"慢性复发型","C":"慢性持续型","D":"急性暴发型","E":"临床终末型"},"da_an":"B","typeid":"117","time":"2018-10-30 17:42:16","xiang_jie":"[考点]溃疡性结肠炎的临床分型\r\n[考点还原]（P386）\u201c慢性复发型：临床上最多见（B对），发作期与缓解期交替\u201d。\r\n[解析]溃疡性结肠炎按其病程、程度、范围及病期进行综合分型，可分为初发型、慢性复发型、慢性持续型和急性暴发型，其中以慢性复发型最多见。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"407","all_num":"504","types":0,"pname":"内科学"},{"id":"10018","name":"急性腐蚀性胃炎是由于吞服：","data":{"A":"硝酸","B":"盐酸","C":"水杨酸","D":"亚硝酸盐"},"da_an":"A@B","typeid":"117","time":"2018-10-30 17:43:45","xiang_jie":"[答案]AB\r\n[考点]急性腐蚀性胃炎的病因\r\n[考点还原]（P875）\u201c表9-2-1  常见急性中毒诊治要点\u201d（AB对）。\r\n[解析]引起急性腐蚀性胃炎的毒物是强酸或强碱类，因为硝酸和盐酸为强酸类，所以吞服后可引起急性腐蚀性胃炎，而水杨酸和亚硝酸盐属弱酸类，所以吞服后不会引起急性腐蚀性胃炎。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"227","all_num":"495","types":0,"pname":"内科学"},{"id":"10019","name":"下列关于胃的良性与恶性溃疡鉴别要点的叙述，正确的是：","data":{"A":"早期溃疡型胃癌单凭内镜所见不难与良性溃疡鉴别","B":"活组织检查可以确定良性或恶性溃疡","C":"即使内镜下诊断为良性溃疡且活检阴性，仍有漏诊恶性溃疡的可能","D":"胃镜复查溃疡愈合不是鉴别良性与恶性溃疡的可靠依据"},"da_an":"B@C@D","typeid":"117","time":"2018-10-30 17:45:03","xiang_jie":"[答案]BCD\r\n[考点]胃良性与恶性溃疡的鉴别\r\n[考点还原]（七版内科学P391）\u201cⅢ型（溃疡型） 早期胃癌单凭内镜所见与良性溃疡鉴别有困难（A错），放大内镜和染色内镜对鉴别有帮助，但最终必须依靠直视下取活组织检查鉴别（B对）\u201d。（七版内科学P391）\u201c即使内镜下诊断为良性溃疡且活检阴性，仍有漏诊胃癌的可能\u201d（C对）。（七版内科学P391）\u201c胃镜复查溃疡缩小或愈合不是鉴别良、恶性溃疡的最终依据，必须重复活检加以证实\u201d（D对）。\r\n[解析]内镜或X线检查见到胃的溃疡必须鉴别其为良性或恶性，早期溃疡型胃癌单凭内镜所见很难与良性溃疡鉴别，二者非常相似，必须依靠直视下取活组织检查鉴别，因此A项叙述是错误的，其余3项均正确。\r\n","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"238","all_num":"518","types":0,"pname":"内科学"},{"id":"10508","name":"多灶萎缩性胃窦炎最主要的病因是","data":{"A":"胆汁反流   ","B":"口服非甾体抗炎药","C":"幽门螺杆菌感染 ","D":"自身免疫性抗体"},"da_an":"C","typeid":"117","time":"2018-11-24 10:36:48","xiang_jie":"C  ①慢性萎缩性胃炎分为多灶萎缩性胃炎和自身免疫性胃炎两类。前者好发于胃窦部，多由 幽门螺杆菌感染引起的慢性非萎缩性胃炎发展而来。后者好发于胃体部，多由自身免疫引起的胃体胃炎发展而来。参阅7版内科学P383。②胆汁反流、口服非甾体抗炎药物是慢性胃炎的少见病因。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"421","all_num":"518","types":0,"pname":"内科学"},{"id":"10509","name":"球后溃疡的临床特点是","data":{"A":"上腹痛常无典型的节律性    ","B":"午夜痛和背部放射痛多见","C":"对药物治疗反应较好 ","D":"不易并发出血"},"da_an":"B","typeid":"117","time":"2018-11-24 10:37:32","xiang_jie":"B 球后溃疡是指发生于十二指肠降段、水平段的溃疡，多具有十二指肠溃疡的临床特点，但夜间痛和背部放射痛更为多见，对药物治疗反应稍差，较易并发出血。参阅3版8年制内科学P468。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"441","all_num":"474","types":0,"pname":"内科学"},{"id":"10510","name":"男性，51岁。肝硬化病史4年，发生呕血、黑便2天，半天来出现意识模糊和躁动人院。为清除该患者的肠道内积血，最宜选用的灌肠液是","data":{"A":"弱酸性液    ","B":"弱碱性液  ","C":"肥皂水","D":"温开水"},"da_an":"A","typeid":"117","time":"2018-11-24 10:39:01","xiang_jie":"A  ①患者长期肝硬化病史，上消化道出血后突然出现意识障碍，应诊断为肝性脑病，为氨中毒所致。②NH4+不能通过血脑屏障达脑部，相对无毒。能通过血脑屏障，促发肝性脑病的神经毒素是NH3。NH，和NH4+的相互转化受pH梯度改变的影响，NH3在酸性环境下(pH<6．O)，可与H+结合形成毒性小的NH4+随粪便排出体外。在碱性环境下，如当结肠pH> 6.0时，NH4+离解为NH3和H+，NH，大量弥散人血，导致肝性脑病。为清除患者肠道内积血，减少血氨形成，可采用弱酸性溶液灌肠(A)。③肥皂水多为弱碱性溶液，会增加血氨吸收；温开水不能减少血氨形成，均不宜使用。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"384","all_num":"467","types":0,"pname":"内科学"},{"id":"10511","name":"男性，32岁。间断发作下腹痛、腹胀伴腹泻或便秘3年余，下腹痛不重，多于排 便后缓解，粪便常有黏液，无脓血。3周来再次发作下腹痛伴腹泻，大便2~4次／天，粪便性状同前。体楮检查除下腹部有轻度压痛外，其余未见异常。粪便常规、隐血及培养均未发现明显异常。患者最可能的诊断是","data":{"A":"肠结核 ","B":"克罗恩病","C":"肠易激综合征","D":"溃疡性结肠炎"},"da_an":"C","typeid":"117","time":"2018-11-24 10:43:34","xiang_jie":"①年轻患者，长期间断下腹痛，排便后可缓解，无脓血便，多种检查均为阴性，应孝虑功能性肠病（肠易激综合征）。肠结核、克罗恩病、溃疡性结肠炎均为器质性病变，粪便常规、隐血及培养均可有阳性发现。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"481","all_num":"507","types":0,"pname":"内科学"},{"id":"10512","name":"男性，32岁。间断发作下腹痛、腹胀伴腹泻或便秘3年余，下腹痛不重，多于排 便后缓解，粪便常有黏液，无脓血。3周来再次发作下腹痛伴腹泻，大便2~4次／天，粪便性状同前。体楮检查除下腹部有轻度压痛外，其余未见异常。粪便常规、隐血及培养均未发现明显异常。为确定诊断，最有意义的检查是","data":{"A":"PPD试验","B":"腹部B超 ","C":"钡剂灌肠 ","D":"结肠镜"},"da_an":"D","typeid":"117","time":"2018-11-24 10:45:02","xiang_jie":"②为明确肠易激综合征的诊断，应首选纤维结肠镜检查，若无阳性发现，有助于诊断(D)。PPD试验多用于诊断肠结核。腹部B超对肠易激综合征的诊断价值不大。钡剂灌肠多用于克罗恩病、溃疡性结肠炎的诊断。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"470","all_num":"496","types":0,"pname":"内科学"},{"id":"10513","name":"男性，32岁。间断发作下腹痛、腹胀伴腹泻或便秘3年余，下腹痛不重，多于排 便后缓解，粪便常有黏液，无脓血。3周来再次发作下腹痛伴腹泻，大便2~4次／天，粪便性状同前。体楮检查除下腹部有轻度压痛外，其余未见异常。粪便常规、隐血及培养均未发现明显异常。可选择的治疗是","data":{"A":"口服抗结核药","B":"口服柳氮磺吡啶","C":"口服匹维溴胺","D":"口服布地奈德"},"da_an":"C","typeid":"117","time":"2018-11-24 10:46:47","xiang_jie":"C  ①年轻患者，长期间断下腹痛，排便后可缓解，无脓血便，多种检查均为阴性，应孝虑功能性肠病（肠易激综合征）。肠结核、克罗恩病、溃疡性结肠炎均为器质性病变，粪便常规、隐血及培养均可有阳性发现。②为明确肠易激综合征的诊断，应首选纤维结肠镜检查，若无阳性发现，有助于诊断(D)。PPD试验多用于诊断肠结核。腹部B超对肠易激综合征的诊断价值不大。钡剂灌肠多用于克罗恩病、溃疡性结肠炎的诊断。③匹维溴胺为选择性作用于胃肠道平滑肌的钙通道阻滞剂，可缓解腹痛(C)。A多用于肠结核的治疗。BD多用于溃疡性结肠炎的治疗。\r\n","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"444","all_num":"501","types":0,"pname":"内科学"},{"id":"10514","name":"有机磷中毒时，患者的呼吸气味常是","data":{"A":"烂苹果味","B":"苦杏仁味","C":"蒜臭味","D":"腥臭味"},"da_an":"C","typeid":"117","time":"2018-11-24 10:51:38","xiang_jie":"①有机磷农药中毒时，患者的呼吸气味常呈蒜臭味(C)。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"393","all_num":"505","types":0,"pname":"内科学"},{"id":"10515","name":"氰化物中毒时，患者的呼吸气味常是","data":{"A":"烂苹果昧  ","B":"苦杏仁味","C":"蒜臭味 ","D":"腥臭味"},"da_an":"B","typeid":"117","time":"2018-11-24 10:52:56","xiang_jie":"①有机磷农药中毒时，患者的呼吸气味常呈蒜臭味②氰化物中毒时，患者的呼吸气味常呈苦杏仁味(B)。③糖尿病酮症酸中毒时，患者的呼吸气味常呈烂苹果味。肝性脑病患者呼吸气体呈腥臭味。","jie_du":null,"ti_type":"1","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"490","all_num":"524","types":0,"pname":"内科学"},{"id":"10516","name":"有机磷中毒时的毒蕈碱样症状有","data":{"A":"腹痛、腹泻  ","B":"大汗、流涎","C":"肌纤维颤动  ","D":"瞳孔缩小"},"da_an":"A@B@D","typeid":"117","time":"2018-11-24 10:56:17","xiang_jie":"ABD  有机磷农药中毒可导致毒草碱样症状、烟碱样症状和中枢神经系统症状。ABD均属于毒蕈碱样症状，C为烟碱样症状。","jie_du":null,"ti_type":"2","ti_shu":"0","fen_num":"1","ping_num":"0","ok_num":"277","all_num":"499","types":0,"pname":"内科学"}]
         * ban_ben : null
         */

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        public Object getBan_ben() {
            return ban_ben;
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        public void setBan_ben(Object ban_ben) {
            this.ban_ben = ban_ben;
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        public List<ListBean> getList() {
            return list;
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        public void setList(List<ListBean> list) {
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        public static class ListBean {
            /**
             * id : 69
             * name : 阿司匹林引起NSAID溃疡的最主要致溃疡机制是：
             * data : {"A":"抑制COX-1","B":"抑制COX-2","C":"同时抑制COX-1和COX-2","D":"局部作用"}
             * da_an : A
             * typeid : 117
             * time : 2005-07-01 14:38:19
             * xiang_jie : [答案]A
             * [考点]阿司匹林的作用机制
             * [考点还原]（P363）“NSAIDs致胃黏膜病变的主要机理是通过小肠吸收后，对黏膜COX-1抑制，因此，肠溶型的NSAIDs依旧可以导致急性胃炎”（A对）。
             * [解析]NSAID的系统作用主要是抑制环氧合酶（COX）。COX有两种异构体，即COX-1和COX-2。COX-1催化生理性前列腺素合成，参与机体正常生理功能调节及保护，如维持胃肠黏膜完整。COX-2主要在病理情况下由炎症刺激诱导产生，促进炎症部位前列腺素的合成。传统的NSAID如阿司匹林抑制了COX-1，使胃肠黏膜生理性前列腺素E合成不足，导致胃肠道出现黏膜病变（溃疡）。
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             * fen_num : 1
             * ping_num : 0
             * ok_num : 2042
             * all_num : 2706
             * types : 0
             * pname : 内科学
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            private int types;
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                return id;
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            public void setId(String id) {
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                return name;
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            public void setName(String name) {
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            public void setData(DataBean data) {
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            public String getTypeid() {
                return typeid;
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            public void setTypeid(String typeid) {
                this.typeid = typeid;
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            public String getTime() {
                return time;
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            public void setTime(String time) {
                this.time = time;
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            public String getXiang_jie() {
                return xiang_jie;
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            public void setXiang_jie(String xiang_jie) {
                this.xiang_jie = xiang_jie;
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            public Object getJie_du() {
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            public void setJie_du(Object jie_du) {
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            public String getTi_type() {
                return ti_type;
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            public void setTi_type(String ti_type) {
                this.ti_type = ti_type;
            }

            public String getTi_shu() {
                return ti_shu;
            }

            public void setTi_shu(String ti_shu) {
                this.ti_shu = ti_shu;
            }

            public String getFen_num() {
                return fen_num;
            }

            public void setFen_num(String fen_num) {
                this.fen_num = fen_num;
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            public String getPing_num() {
                return ping_num;
            }

            public void setPing_num(String ping_num) {
                this.ping_num = ping_num;
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            public String getOk_num() {
                return ok_num;
            }

            public void setOk_num(String ok_num) {
                this.ok_num = ok_num;
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            public String getAll_num() {
                return all_num;
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            public void setAll_num(String all_num) {
                this.all_num = all_num;
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            public int getTypes() {
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            public void setTypes(int types) {
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            public String getPname() {
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            public void setPname(String pname) {
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                /**
                 * A : 抑制COX-1
                 * B : 抑制COX-2
                 * C : 同时抑制COX-1和COX-2
                 * D : 局部作用
                 */

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                private String C;
                private String D;
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                public String getE() {
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                public void setE(String E) {
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}
